Synopsis
Recognise mechanical, thrombotic and infectious central venous catheter complications, stabilise the patient, protect the vessel and device, and choose investigation and source control without unsafe line manipulation.
- After suspected large-bore arterial cannulation, stop infusions and leave a catheter or dilator of at least 6 Fr in place; obtain urgent vascular or interventional-radiology advice for imaging and controlled removal or repair.
- For acute respiratory or circulatory deterioration, stop catheter use and assess immediately for pneumothorax, haemothorax, air embolism, tamponade, malposition and bleeding; treat the life-threatening physiology before routine line troubleshooting.
- For fever, rigors or shock, obtain appropriate cultures without delaying sepsis treatment, examine the exit site and tunnel, and plan source control; severe, recurrent or S. aureus dialysis-catheter bacteraemia usually favours catheter replacement or removal.
Key red flags
Sudden dyspnoea, hypoxaemia, pleuritic pain or hypotension after neck or chest access suggests pneumothorax, haemothorax, air embolism or pericardial injury.
A new focal neurological deficit, pulsatile neck swelling, rapidly expanding haematoma or arterial pressure waveform suggests arterial cannulation, dissection, embolisation or compressive bleeding.
Rigors, hypotension, confusion or new organ dysfunction during catheter use may be catheter-related bloodstream infection even when the exit site appears normal.
Arm, neck or facial swelling, collateral veins, catheter dysfunction or unexplained pulmonary symptoms raises catheter-related thrombosis or central venous stenosis.
Abrupt cough, dyspnoea, chest pain, hypoxaemia, hypotension or neurological change during connection, disconnection or removal should prompt immediate clamping and resuscitation.
Investigation priorities
Determine physiological threat and whether the catheter is safe to use before diagnostic delay.
Management branches
Respiratory, circulatory or neurological compromise, major bleeding, or suspected large-bore arterial cannulation occurs.
- Stop catheter use, call the resuscitation and procedural teams, support airway, breathing and circulation, and identify whether air entry, thoracic injury, arterial injury or tamponade best explains the timing.
- For a catheter or dilator of at least 6 Fr in an artery, leave it in place and obtain urgent vascular or interventional-radiology review for imaging and controlled repair; do not perform blind pull-and-pressure removal.
Local catheter inflammation, bacteraemia or systemic features are present without shock or another immediate mechanical threat.