INSERTION-RELATED COMPLICATIONS

Pneumothorax
(continued)

Symptoms of pneumothorax include:

• Sharp chest pain, made worse by a deep breath or cough
• Shortness of breath
• Nasal flaring
• Hypotension
• A larger pneumothorax results in chest tightness, rapid heart rate or cyanosis (36).

Prevention/Management
During subclavian approach, maintain a shallow angle while inserting the needle and refrain from deep insertion. Consider removing high levels of PEEP for line insertion.

During IJ approach, maintain an acute angle that directs the needle away from the apex of the lung, when possible use ultrasound guidance.

If the patient develops acute dyspnea, perform needle decompression (or chest tube placement) and order an emergency radiograph. In case of pneumothorax or if chest tube is already present, subsequent central venous catheter placements should be performed on the same side of the thorax to avoid bilateral pneumothorax (16).