This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (45)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

John F. Robinson, MD; William A. Robinson, MD, PhD; Allen Cohn, MD; Kavita Garg, MD; John D. Armstrong II, MA, MD

Arch Intern Med. 1995;155(11):1225-1228.

Abstract
Background
Placement of central venous lines for the administration of a variety of therapies has become common practice. The most severe complication of this procedure is perforation of a large vessel, with bleeding, 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 placement occurring between 1986 and 1993 at the University Hospital, the major teaching facility of the University of Colorado Health Sciences Center, Denver. Data collected included the age and sex of the patient, diagnosis, type of catheter and site of placement, operator, means and time to the diagnosis of perforation, and outcome.

Results
Eleven such complications were identified and 10 of them are reviewed in detail. The overall incidence was less than 1%. Most complications occurred when the right subclavian vein approach was attempted, and they were thought to result from guidewire kinking during advancement of a vessel dilator. All medical specialties and levels of training were involved. Four of 10 patients died of immediate or subsequent complications of the perforation.

Conclusions
Perforation of a great vessel is an uncommon, but often fatal, complication of central venous line placement. It occurs most often, when using the right subclavian vein approach, from guidewire kinking. Physicians performing this procedure should have formal training in central venous catheterization and be aware of this complication, its presumed cause, diagnosis, and treatment.

(Arch Intern Med. 1995;155:1225-1228)

Author Affiliations
From the Departments of Medicine (Drs J. F. Robinson, W. A. Robinson, and Cohn), and Radiology (Drs Garg and Armstrong), University of Colorado Health Sciences Center, Denver.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Is Traditional Reading of the Bedside Chest Radiograph Appropriate To Detect Intraatrial Central Venous Catheter Position?
Wirsing et al.
Chest 2008;134:527-533.
ABSTRACT | FULL TEXT  

Vascular Access in the Adult Home Infusion Patient
Sands
JPEN J Parenter Enteral Nutr 2006;30:S57-S64.
ABSTRACT | FULL TEXT  

A Curricular Initiative for Internal Medicine Residents to Enhance Proficiency in Internal Jugular Central Venous Line Placement
Ramakrishna et al.
Mayo Clin Proc. 2005;80:212-218.
ABSTRACT  

Guidelines for the Prevention of Intravascular Catheter-Related Infections
O'Grady et al.
Pediatrics 2002;110:e51-51.
ABSTRACT | FULL TEXT  

Central Venous Access: A Primer for the Diagnostic Radiologist
Funaki
Am. J. Roentgenol. 2002;179:309-318.
FULL TEXT  

Central venous catheterization and fatal cardiac tamponade
Booth et al.
Br J Anaesth 2001;87:298-302.
ABSTRACT | FULL TEXT  

Therapeutic embolization of an internal mammary artery damaged by placement of a central venous catheter
Abbott and Evans
Br J Anaesth 2001;86:143-145.
ABSTRACT | FULL TEXT  

Prevention of Intravascular Catheter-Related Infections
Mermel
ANN INTERN MED 2000;132:391-402.
ABSTRACT | FULL TEXT