title: [Injuries to blood vessels near the heart caused by central venous catheters].
abstract: Injuries to blood vessels near the heart can quickly become life-threatening and include arterial injuries during central venous puncture, which can lead to hemorrhagic shock. We report 6 patients in whom injury to the subclavian artery and vein led to life-threatening complications. Central venous catheters are associated with a multitude of risks, such as venous thrombosis, air embolism, systemic or local infections, paresthesia, hemothorax, pneumothorax, and cervical hematoma, which are not always immediately discernible. The subclavian catheter is at a somewhat lower risk of catheter-associated sepsis and symptomatic venous thrombosis than approaches via the internal jugular and femoral veins. Indeed, access via the subclavian vein carries a substantial risk of pneumo- and hemothorax. Damage to the subclavian vein or artery can also occur during deliberate and inadvertent punctures and result in life-threatening complications. Therefore, careful consideration of the access route is required in relation to the patient and the clinical situation, to keep the incidence of complications as low as possible. For catheterization of the subclavian vein, puncture of the axillary vein in the infraclavicular fossa is a good alternative, because ultrasound imaging of the target vessel is easier than in the subclavian vein and the puncture can be performed much further from the lung.
authors.affiliation: Univ.-Kinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, 6020, Innsbruck, Österreich.
authors.forename: J
authors.initials: J
authors.lastname: Abram
authors.affiliation: Univ.-Klinik für Gefäßchirurgie, Medizinische Universität Innsbruck, Innsbruck, Österreich.
authors.forename: J
authors.initials: J
authors.lastname: Klocker
authors.affiliation: Univ.-Kinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, 6020, Innsbruck, Österreich.
authors.forename: N
authors.initials: N
authors.lastname: Innerhofer-Pompernigg
authors.affiliation: Univ.-Kinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, 6020, Innsbruck, Österreich.
authors.forename: M
authors.initials: M
authors.lastname: Mittermayr
authors.affiliation: Univ.-Klinik für Radiologie, Medizinische Universität Innsbruck, Innsbruck, Österreich.
authors.forename: M C
authors.initials: MC
authors.lastname: Freund
authors.affiliation: Univ.-Klinik für Anästhesie und Intensivmedizin, University of Florida, Gainesville, USA.
authors.forename: N
authors.initials: N
authors.lastname: Gravenstein
authors.affiliation: Bodensee Medizin Campus, Klinik für Anästhesie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Röntgenstraße 2, 88048, Friedrichshafen, Deutschland. v.wenzel@klinikum-fn.de.
authors.forename: V
authors.initials: V
authors.lastname: Wenzel
mesh_terms: D000293:Adolescent; D001488:Basilar Artery / Q000000981:diagnostic imaging / Q000293:injuries; D001808:Blood Vessels / Q000000981:diagnostic imaging / Q000293:injuries*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D062905:Central Venous Catheters / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging / Q000293:injuries; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000293:injuries; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000293:injuries
keywords: Axillary vein; Central venous catheterization; Hemothorax; Subclavian artery; Subclavian vein