This is a rare complication of subclavian venopuncture:
Inadvertent subclavian arterial puncture
In inexperienced hands it could be a fatal procedure. So, in this case, it was too late when we try to stop that massive bleeding after a surgery interconsultation.
Regards,
Jon Mikel Iñarritu, M.D.
technorati tags: hemomediastinum, subclavian venopuncture, mediastinal hematoma, surgery, medicine, medicina, unbounded medicine
I Think it is a safe procedure but still has some riks. Even in experienced hands like any others invasive procedures. However for some indications could be not risk-benefit.A way to reduce the incidence of complications coud be to review its indications and the level of evidence to support its impact in mortality, reduction in hospitalization days, etc. In México nowdays in The Nationals Institutes of Helth the initial placement of a periferal access central line is the initial practice in most patients.
I agree with you, it’s safer to place an IJ line than a SC central line.
I really like your step-by-step procedure.
Just one thing, ultrasound guidance of SC catheterization was not beneficial. Please, read this:
Mansfield PF, Hohn DC, Fornage BD, Gregurich MA, Ota DM. Complications and failures of subclavian-vein catheterization.N Engl J Med. 1994;331:1735-8.
Regards,
Jon Mikel Iñarritu, M.D.
IJ central line placement is generally safer than SC especially with ultrasound like SiteRite – check out the guides for IJ TLC placement with and without ultrasound guidance.
Other complications of TLC are pneumothorax and arrhythmia.