Tension haemopneumothorax as a complication of subclavian central venous access and pressure infusion

Abstract

A haemodynamically unstable patient following a gunshot wound who required large gauge central venous access for resuscitation developed a tension haemopneumothorax as a complication of subclavian central venous catheter malplacement and pressure infusion of blood products. Placement of the line was not straightforward and clinical markers of misplacement, such as negative aspiration of blood on insertion or failure of drugs or fluids infused through the line, were not immediately recognized and these failures are discussed. If there is any clinical doubt about a central venous catheter placement, the line must not be used for pressure infusion as complications can arise that are more immediately life-threatening than the original injury. Large bore peripheral access should always be sought where clinically possible to allow ongoing volume resuscitation via this route during central line insertion, and if necessary afterwards until radiological confirmation is obtained.