Complications of central venous catheterization in adults and children

Implantation of a central venous catheter carries the risk of many and various complications, such as pneumothorax, cardiac arrhythmia, air embolism, haematomas, lesions of the central or peripheral nervous system, pericardial tamponade, thromboses, and injury to the thoracic duct or the respiratory tract. Acute cardiac arrhythmias, but also haematomas and pneumothoraces are most frequently observed. The range of complications clearly shows that both the implantation and the utilization of a central venous catheter demand increased vigilance and attention as well as regular monitoring to recognize complications at an early stage and prevent severe injury. Special emphasis needs to be placed on prophylaxis. This implies, above all, restrictive indications for the placement of a central venous catheter, a sound theoretical and practical education of the physicians, and regular care and check-up of the catheter. Preference should be given to the puncture of the right internal jugular vein, because this type of venous access tends to be associated with a lower rate of complications. In the last few years, a growing number of publications have emerged which strongly favour of the use of ultrasound in the insertion of central venous lines. Recent data suggest that ultrasound-guided puncture is particularly recommended for children and for patients with coagulation disorders or aberrant veins, and also for physicians who are not yet sufficiently experienced in the placement of a central venous catheter.