Complications (in the neck or chest) (12). Puncture of

Complications of CVC include early or late complications.
Early complications occur from insertion time to the first use of catheter and
include pneumothorax, hemothorax, primary malposition, arrhythmias, air
embolism, and arterial perforation which can cause bleeding. Early
complications mainly occur in conventional CVC due to placement of the catheter
percutaneously, especially into the central vein of the chest (internal jugular
or subclavian veins) or groin (femoral vein).  Pneumothorax or hemothorax is impossible with
peripheral CVC. Other major early complications such as primary malposition,
air embolism or arterial perforation have also been showed to be lowest in
peripheral sites as opposed to central placement of catheter (in the neck or
chest) (12). Puncture of major artery at
the periphery, if it occurs, can easily be controlled by compression. In
comparing catheters placed percutaneously in the chest, a recent prospective,
non randomized, observational study in 1,201 patients reported higher
complications rate of catheter placed through subclavian approach over
internal jugular approach (13).

 

Late
complications refer to events that occur after the first use of catheter. These
include extravasation injuries; mechanical complications which depend on
technical aspect of catheter insertion (fractures, pinch off, dislodgement or
migration); catheter and vein thrombosis/occlusion (including deep vein
thrombosis, pulmonary embolism, or SVC syndrome); infections (including phlebitis
of the cannulated vessel) (10).

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Extravasation
can occur when there is migration of the catheter into a smaller vein, rupture
or tear in the catheter and perforation of the SVC wall. Catheter rupture can
occur due to an excessive force used when flushing the occluded catheter.

 

A
pinch-off syndrome is basically due to compression of a large-bore silicone
catheter between the clavicle and the first rib via the infraclavicular
“blind” venipuncture of the subclavian vein. The compression may result
in catheter obstruction, damage or fracture. Using alternative venipuncture
approach other than the infraclavicular route can minimize this risk.

 

Thrombosis/occlusion
of the catheter or vein is also a recognized late complication of CVC. The
likelihood of developing catheter-related thrombosis are related to catheter
material, 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-related
infection, the presence of congestive heart failure and hypercoagulable states
have also been identified as potential risk. Cancer and chemotherapy are the
recognized risk factors for development of central venous thrombosis in
patients with a CVC due to hypercoagulability from the direct release of
thrombogenic factors by neoplastic cells, decrease in natural antithrombotic
factors induced by the tumour and the pro-coagulant activity of various
chemotherapy drugs (10).