Delayed Pneumothorax: A Complication of Subclavian Vein Catheterization

Abstract

Subclavian catheterization is a reliable, well-described technique of central venous access for a variety of indications. Significant complications are associated with the procedure. Detection of the majority of complications is afforded by the postinsertion chest x-ray. Delayed pneumothorax, a relatively unrecognized complication of subclavian catheterization, is caused by a slow pleural air leak which appears to be associated with the "difficult" insertion as illustrated by three case reports. A repeat or "delayed" chest roentgenogram should be considered in the following situations: (1) Difficult subclavian insertions requiring multiple attempts. (2) Suspicion of pleural injury such as aspiration of air during insertion or subcutaneous emphysema with a normal postinsertion chest x-ray. (3) The presence of another major complication. (4) If the patient complains of persistent pleuritic or back pain after insertion. (5) Preoperatively after previous difficult insertion of a central venous line. (6) Postoperatively when a subclavian catheter is inserted intraoperatively. (Journal of Parenteral and Enteral Nutrition 8:571-574, 1984)