Complications opposed to central placement of catheter (in

Complications of CVC include early or late complications.Early complications occur from insertion time to the first use of catheter andinclude pneumothorax, hemothorax, primary malposition, arrhythmias, airembolism, and arterial perforation which can cause bleeding. Earlycomplications mainly occur in conventional CVC due to placement of the catheterpercutaneously, especially into the central vein of the chest (internal jugularor subclavian veins) or groin (femoral vein).

 Pneumothorax or hemothorax is impossible withperipheral CVC. Other major early complications such as primary malposition,air embolism or arterial perforation have also been showed to be lowest inperipheral sites as opposed to central placement of catheter (in the neck orchest) (12). Puncture of major artery atthe periphery, if it occurs, can easily be controlled by compression. Incomparing catheters placed percutaneously in the chest, a recent prospective,non randomized, observational study in 1,201 patients reported highercomplications rate of catheter placed through subclavian approach overinternal jugular approach (13). Latecomplications refer to events that occur after the first use of catheter.

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Theseinclude extravasation injuries; mechanical complications which depend ontechnical aspect of catheter insertion (fractures, pinch off, dislodgement ormigration); catheter and vein thrombosis/occlusion (including deep veinthrombosis, pulmonary embolism, or SVC syndrome); infections (including phlebitisof the cannulated vessel) (10). Extravasationcan occur when there is migration of the catheter into a smaller vein, ruptureor tear in the catheter and perforation of the SVC wall. Catheter rupture canoccur due to an excessive force used when flushing the occluded catheter. Apinch-off syndrome is basically due to compression of a large-bore siliconecatheter between the clavicle and the first rib via the infraclavicular”blind” venipuncture of the subclavian vein. The compression may resultin catheter obstruction, damage or fracture.

Using alternative venipunctureapproach other than the infraclavicular route can minimize this risk.  Thrombosis/occlusionof the catheter or vein is also a recognized late complication of CVC. Thelikelihood of developing catheter-related thrombosis are related to cathetermaterial, type of catheter used, the number of inserted and changed catheters,number of punctures during catheter insertion, location of catheter tip,duration of catheterization and type of infusate.  Other factors such as catheter-relatedinfection, the presence of congestive heart failure and hypercoagulable stateshave also been identified as potential risk. Cancer and chemotherapy are therecognized risk factors for development of central venous thrombosis inpatients with a CVC due to hypercoagulability from the direct release ofthrombogenic factors by neoplastic cells, decrease in natural antithromboticfactors induced by the tumour and the pro-coagulant activity of variouschemotherapy drugs (10).

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