INSERTION-RELATED COMPLICATIONS

Nerve Injury
CVC insertion sites are often proximal to nerves, particularly the brachial plexus and phrenic nerve. As a result, during CVC placement, some nerves may become accidentally injured. The damage to the nerve can be by puncture, cut or complete severance.

Symptoms of nerve injury include:

• Involuntary jerking reaction from patient during insertion procedure
• Feeling of electrical shock shooting down the arm
• Numbness or tingling associated with the extremity where the insertion occurred
• Temperature changes in the extremity

Prevention/Management The best prevention to nerve damage is to know your anatomy and to use ultrasound guidance during all CVC insertion procedures. Remove the needle immediately if the patient reports tingling or stinging during insertion and assess the patient's neurovascular status if the patient reports any symptoms (11).


Bleeding/Hemorrhage

Excessive bleeding at the insertion site is usually caused by a traumatic insertion or the use of a large introducer. Excessive bleeding may also be the sign of accidental arterial insertion or the development of a thrombosis.

Symptoms of hemorrhage include:

• Persistent bleeding
• Hematoma expanding ecchymosis at the insertion site