From the Guidelines
Central Venous Pressure (CVP) catheter insertion via the Subclavian vein is associated with a higher risk of complications, including pneumothorax and malposition, compared to other insertion sites.
Complications of CVP Catheter Insertion
- Pneumothorax: a small percentage of patients experience pneumothorax, with subclavian catheters having a higher risk compared to jugular catheters 1
- Malposition: approximately 10% of chest radiographs demonstrate malpositioned catheters, with subclavian catheters having a higher risk of malposition compared to jugular catheters 1
- Mechanical complications: subclavian catheters have a higher risk of mechanical complications, including pneumothorax and malposition, compared to internal jugular vein catheters 1
- Infectious complications: while some studies suggest that subclavian catheters may have a lower risk of catheter-related infections compared to jugular catheters, the evidence is not conclusive 1
Recommendations for CVP Catheter Insertion
- Internal jugular vein: may be a preferred site for CVP catheter insertion due to lower risk of mechanical complications 1
- Subclavian vein: may be associated with a higher risk of complications, but can be used for long-term access with proper technique and care 1
- Femoral vein: relatively contraindicated due to high risk of infection and thrombosis 1
From the Research
Complications of Central Venous Pressure (CVP) Catheter Insertion via the Subclavian Vein
The insertion of a Central Venous Pressure (CVP) catheter via the Subclavian vein can be associated with several complications. These include:
- Pneumothorax: a major complication of Subclavian vein catheterization 2, 3, 4
- Arterial puncture: a frequent immediate complication of catheterism 3, 4
- Arrhythmias: a potential complication of catheter insertion 3, 4
- Malposition: a rare but possible complication of catheter insertion, even with ultrasound guidance 5
- Thrombosis: a late complication of catheterization, more common with femoral vein catheterization but possible with Subclavian vein catheterization 3, 4
- Infection: a late complication of catheterization, correlated with catheter and vessel thrombosis 3, 4
- Accidental venous puncture: a possible complication of Subclavian vein catheterization 4
- Hemo- and pneumothorax: a potential complication of Subclavian vein catheterization 2
Severity and Management of Complications
The severity of these complications can vary, and some may be fatal 2. However, with proper technique, operator experience, and management of the device, the risk of complications can be decreased 6, 4. The use of ultrasound guidance can also reduce the risk of complications, such as pneumothorax and malposition 3, 5.
Success Rate and Morbidity
The success rate of Subclavian central venous catheter placement can be close to 100%, with severe complications below 2% and zero mortality, if performed by trained personnel in patients without risk factors and with limited attempts 6.