DELAYED PNEUMOTHORAX AFTER CENTRAL VENOUS ACCESS - A POTENTIAL HAZARD

Percutaneous central venous catheter access is commonplace in surgical patients. Though several major complications of this procedure have b een described, pneumothorax is the most common. Pneumothorax is routin ely assessed by a chest X-ray within 2 hours after catheter placement. 1-4 During a recent 6-month interval, the authors identified five pati ents with delayed onset and diagnosis of pneumothorax following percut aneous central venous access. All immediate post-insertion chest X-ray s were normal; however, subsequent chest X-ray showed evidence of pneu mothoraxes. The pneumothorax contributed to the death of one patient o n positive pressure ventilation. A review of the literature revealed a total of 18 patients in the English literature with this complication . Although the incidence of delayed pneumothorax is low, it is, in som e instances, life threatening, particularly in patients on positive pr essure ventilation. A high index of suspicion is required to diagnosis and treat this reversible condition.