Central Venous Access: Hazards & Complications 

1. Mechanical Complications (Early / During Insertion) – most common at time of placement 

Vessel & surrounding structure injury: 

Arterial puncture (carotid, subclavian, femoral) 
Haematoma 
Bleeding 

Lung & thoracic complications: 

Pneumothorax (- with subclavian & IJ lines) 
Haemothorax 
Air embolism 

Heart & nerve injury: 

Arrhythmias (irritation from the line at time of insertion) 
Cardiac tamponade (rare) 
Nerve injury (brachial plexus, phrenic nerve) 

Catheter problems:
Malposition (e.g., azygos vein, smaller femoral veins) 
Catheter knotting or kinking 

Exam tip: Pneumothorax = most tested complication of subclavian lines 

2. Infectious Complications (Late) – Risk increases with duration 

Exit-site infection 
Catheter-related bloodstream infection (CRBSI) 
Sepsis 
Common organisms 
Staphylococcus aureus 
Coagulase-negative staphylococci 
Gram-negative bacilli 
Candida species 

Nursing focus: redness, pain, swelling, discharge/pus, fever → report immediately 
(Note: In ICU it is common to routinely change lines every 7 days to reduce the risk of line sepsis)
 
3. Thrombotic Complications 

Catheter-associated thrombosis 
Venous thrombosis 
Pulmonary embolism 

Risk factors: 

Femoral site 
Prolonged catheter use 
Large-bore catheters 
Immobility 

Clinical sign: swollen limb, pain, line not flushing

4. Catheter Dysfunction & Line Failure 

Occlusion (clot or fibrin sheath) 
Catheter fracture 
Leakage or extravasation 
Migration or dislodgement 

Nursing alert: resistance on flushing = stop and assess; if patient is receiving inotropes and there is a sudden increase in dose – suspect the line is dislodged and seek support.
Note: the waveform should always be transduced on the most proximal port (earliest opportunity to see if the line has migrated; refer to local policy). 

5. Metabolic & Infusion-Related Complications 

Fluid overload 
Electrolyte imbalance 
Air embolism (during line access or removal) 
Drug toxicity (hyperosmolar solutions) 

6. Key Risks by Site: 



7. Safety

✔ Ultrasound-guided insertion 
✔ Strict aseptic technique 
✔ Secure dressing & fixation 
✔ Daily line review 
✔ Prompt removal if not needed 

Nursing Safety Checks 

Inspect site daily 
Maintain sterile access technique 
Flush correctly 
Document complications 
Educate patient 

Summary: 

Central venous lines risk mechanical injury, infection, thrombosis, and catheter malfunction—risk varies by site and duration.