Superior vena cava perforation complicating ultrasound-guided subclavian venous catheterization: A case report

We present a case of a severe mechanical complication (superior vena cava [SVC] perforation) that developed after subclavian vein catheterization using an ultrasound-guided static approach in a patient who underwent right lower lobectomy with video-assisted thoracic surgery. The use of ultrasound during catheterization is reported to reduce mechanical complications. Despite the use of ultrasound in our patient, surgical exploration showed that the catheter placed in the right subclavian vein penetrated the superior portion of the SVC. At the end of the surgery, the catheter was removed under direct visualization. The surgeon attempted to stop bleeding in the SVC by compressing with gauze. However, bleeding could only be stopped by administering a hemostatic matrix. It is concluded that to reduce the incidence or size of iatrogenic perforation of the SVC, catheters with the smallest possible diameter should be used, and the dilator should only be inserted deep enough to enter the vein. If the static approach is used, the modifiedSeldinger technique is useful and to provide training to improve the ultrasound experience, especially if the dynamic approach is used.