Delayed Pneumothorax: A Complication of Subclavian Vein Catheterization

Subclavian catheterization is a reliable, well‐described technique of central venous access for a variety of indications. Significant complications are associated with the procedure. Detection of the majority of complications is afforded by the postinsertion chest x‐ray. Delayed pneumothorax, a relatively unrecognized complication of subclavian catheterization, is caused by a slow pleural air leak which appears to be associated with the “difficult” insertion as illustrated by three case reports. A repeat or “delayed” chest roentgenogram should be considered in the following situations: (1) Difficult subclavian insertions requiring multiple attempts. (2) Suspicion of pleural injury such as aspiration of air during insertion or subcutaneous emphysema with a normal postinsertion chest x‐ray. (3) The presence of another major complication. (4) If the patient complains of persistent pleuritic or back pain after insertion. (5) Preoperatively after previous difficult insertion of a central venous line. (6) Postoperatively when a subclavian catheter is inserted intraoperatively. (Journal of Parenteral and Enteral Nutrition 8:571–574, 1984)