Complications of CVC include early or late complications. Early complications occur from insertion time to the first use of catheter and include pneumothorax, hemothorax, primary malposition, arrhythmias, air embolism, and arterial perforation which can cause bleeding. Early complications mainly occur in conventional CVC due to placement of the catheter percutaneously, especially into the central vein of the chest (internal jugular or subclavian veins) or groin (femoral vein). Pneumothorax or hemothorax is impossible with peripheral CVC.
Other major early complications such as primary malposition, air embolism or arterial perforation have also been showed to be lowest in peripheral sites as opposed to central placement of catheter (in the neck or chest) (12). Puncture of major artery at the periphery, if it occurs, can easily be controlled by compression. In comparing catheters placed percutaneously in the chest, a recent prospective, non randomized, observational study in 1,201 patients reported higher complications rate of catheter placed through subclavian approach over internal jugular approach. Late complications refer to events that occur after the first use of catheter. These include extravasation injuries; mechanical complications which depend on technical aspect of catheter insertion (fractures, pinch off, dislodgement or migration); catheter and vein thrombosis/occlusion (including deep vein thrombosis, pulmonary embolism, or SVC syndrome); infections (including phlebitis of the cannulated vessel).
Extravasation can occur when there is migration of the catheter into a smaller vein, rupture or tear in the catheter and perforation of the SVC wall. Catheter rupture can occur due to an excessive force used when flushing the occluded catheter. A pinch-off syndrome is basically due to compression of a large-bore silicone catheter between the clavicle and the first rib via the infraclavicular “blind” venipuncture of the subclavian vein. The compression may result in catheter obstruction, damage or fracture. Using alternative venipuncture approach other than the infraclavicular route can minimize this risk.
Thrombosis/occlusion of the catheter or vein is also a recognized late complication of CVC. The likelihood of developing catheter-related thrombosis are related to catheter material, type of catheter used, the number of inserted and changed catheters, number of punctures during catheter insertion, location of catheter tip, duration of catheterization and type of infusate. Other factors such as catheter-related infection, the presence of congestive heart failure and hypercoagulable states have also been identified as potential risk. Cancer and chemotherapy are the recognized risk factors for development of central venous thrombosis in patients with a CVC due to hypercoagulability from the direct release of thrombogenic factors by neoplastic cells, decrease in natural antithrombotic factors induced by the tumour and the pro-coagulant activity of various chemotherapy drugs.