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As with many things in life, the success and complication rate directly correlates with the experience of the operator. Overall, however, central venous catheter placement, (especially via right internal jugular vein access) is associated with few complications. Here we will discuss the most common procedural and long-term complications found with internal jugular vein catheterization.
- Carotid artery puncture : In one study, carotid artery puncture occurred during 2% of attempted right IJ cannulations; it is the most common procedural complication of central venous cannulation at this site. Usually the carotid is punctured with the smaller “finder needle,” and only rarely are there serious complications associated with the puncture. Ways to avoid this complication include using ultrasound guidance during difficult cannulations, always moving the needle in a more lateral direction when trying to find the vein, and feeling for the carotid artery medial to the anticipated insertion site. If the finder needle does accidentally pierce the carotid artery, it should be evident by a stream of bright red arterial blood within the syringe. Treatment is to immediately remove the needle and apply external pressure on the site for five full minutes to prevent hematoma formation. Often this will prevent any more serious problems from arising. However, if the large central venous catheter punctures the carotid artery, a serious hematoma could still form despite application of external pressure. In this case it is important to monitor the patient’s airway and hemodynamic status, and it may be advisable to leave the catheter in place and call a vascular surgeon see the patient.
- Pneumothorax: Although pneumothorax is more common during subclavian vein cannulations, it is still reported to occur during .3% of IJ cannulations. A small simple pneumothorax may become a serious tension pneumothorax if the patient is being mechanically ventilated. A small pneumothorax may be treated with radiographic observation alone, whereas a large or tension pneumothorax will need to be treated accordingly, usually with a thoracostomy tube.
- Infection: Infection is by far the most common complication of long-term indwelling catheters, accounting for 150,000 cases of bacteremia and fungemia annually in the U.S. Aseptic technique is still the best protection against infection, and all catheters should be removed as soon as they are no longer needed. Studies show that for long-term use, central venous catheters placed in the subclavian vein have the lowest infection rates, while infection rates for IJ and EJ (external jugular) catheters are slightly higher.
Other rare, but more serious procedural complications of central venous catheter placement include cardiac tamponade (#1 most common fatal complication), arrythmias caused by irritation from the guidewire or losing the guidewire into the vein, and major venous air embolism through the catheter itself. Hopefully, you will not have to deal with these potentially disastrous complications as a medical student; the best prevention is to know what you’re doing and how to do it as safely as possible.
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