# Complications of Central Venous Line Insertion: A Case Series

## TL;DR

This paper presents four rare but serious complications from central venous catheter insertion, emphasizing the need for careful procedures and imaging.

## Contribution

The paper adds to clinical knowledge by documenting uncommon complications and reinforcing procedural best practices.

## Key findings

- A right internal mammary artery aneurysm occurred due to CVC malplacement.
- A retained guidewire in the inferior vena cava was discovered after a year and surgically removed.
- Use of real-time imaging and post-insertion confirmation can reduce complications and improve outcomes.

## Abstract

Central venous catheter (CVC) insertion is a commonly performed procedure in critically ill patients. While generally safe, it carries risks of potentially serious complications, particularly when performed without ultrasound guidance or in emergent settings. We report a series of four patients who developed uncommon but significant complications following CVC placement. The first case describes the right internal mammary artery aneurysm after malplacement of CVC line. The second case outlines the formation of sternocleidomastoid hematoma after internal jugular vein access. The third case involved a guidewire retained in the inferior venacava for over one year, discovered incidentally on imaging and removed surgically. The fourth case developed a subclavian artery pseudoaneurysm post-CVC insertion, confirmed on CT angiography and surgically managed. These cases highlights the importance of strict procedural protocols, operator awareness, use of real-time imaging, and post-insertion confirmation imaging to minimize CVC-related complications. Early identification and appropriate management can significantly reduce morbidity.