Complications, Prevention, and Management
Categories
Complications divide into mechanical (hematoma, arterial puncture, pneumothorax, malposition, air embolism, nerve injury), thrombotic (catheter-related thrombosis, occlusion), and infectious. Each has recognizable early signs and a defined first response.
Prevention
Prevention is procedural: pre-scan the vessel, confirm compressibility, use the smallest appropriate device, secure the catheter, and avoid repeated puncture attempts at the same site. Post-procedure, monitor for bleeding and neurovascular change, and educate the patient to report swelling, pain, or fever.
Management principles
For bleeding, apply direct pressure and reassess distally. For suspected arterial puncture, hold pressure longer and confirm hemostasis before proceeding. For pneumothorax, recognize pleuritic chest pain, dyspnea, and decreased breath sounds, and escalate immediately. For air embolism, place the patient in a position that limits air migration toward the cerebral circulation and give high-flow oxygen while escalating. For suspected infection, obtain cultures as indicated and involve the responsible clinician before device removal decisions.
Traps
Questions often test the first action rather than the definitive treatment. Another trap is misattributing nerve injury symptoms (shooting pain, paresthesia) to expected discomfort, or treating a suspected pneumothorax as anxiety. Avoid the temptation to remove a device reflexively without considering consequences for therapy.
Rule of thumb
First action questions: stop the offending action, stabilize the patient, then escalate.
Worked example
Immediately after subclavian cannulation the patient reports sudden dyspnea with unilateral decreased breath sounds. The first action is to stop the procedure, provide oxygen, and escalate for evaluation of pneumothorax - not to reposition the patient and continue.