PERFORATION OF THE GREAT-VESSELS DURING CENTRAL VENOUS LINE PLACEMENT

Background: Placement of central venous lines for the administration o f a variety of therapies has become common practice. The most severe c omplication of this procedure is perforation of a large vessel, with b leeding, infusion of fluids into an extravascular site, and death. It is not clear from currently available data how often this occurs, what risk factors are associated, and how this complication can be avoided . Methods: We reviewed the records of all patients who were identified as having perforation of a major vessel during central venous line pl acement occurring between 1986 and 1993 at the University Hospital, th e major teaching facility of the University of Colorado Health Science s Center, Denver. Data collected included the age and sex of the patie nt, diagnosis, type of catheter and site of placement, operator, means and time to the diagnosis of perforation, and outcome. Results: Eleve n such complications were identified and 10 of them are reviewed in de tail. The overall incidence was less than 1%. Most complications occur red when the right subclavian vein approach was attempted, and they we re thought to result from guidewire kinking during advancement of a ve ssel dilator. All medical specialties and levels of training were invo lved. Four of 10 patients died of immediate or subsequent complication s of the perforation. Conclusions: Perforation of a great vessel is an uncommon, but often fatal, complication of central venous line placem ent. It occurs most often, when using the right subclavian vein approa ch, from guidewire kinking. Physicians performing this procedure shoul d have formal training in central venous catheterization and be aware of this complication, its presumed cause, diagnosis, and treatment.