Pneumothorax 
Hemothorax 
Hydrothorax(pleural effusion)

(Most common immediately after insertion)

1. Chest x-ray to assess placement after insertion
2. Dry cough & SOB & rapid weak pulse, cold and clammy, diminished or absent breath sounds
3. Subcutaneous emphysema
4. Chest pain

1. Careful insertion
2. Stabilization of catheter
3. Assessing placement by chest x-ray after insertion (especially when inserted via direct subclavian stick).

1. Administer oxygen, place patient in high Fowler's
2. Aspirate air or fluid if possible
3. Remove catheter
4. Chest tubes

Displacement or migration

1. Palpate exit site and tunnel for coiling
2. Distended neck veins
3. Edema around insertion site (often neck and shoulder)
4. Unable to infuse and/or withdraw fluids

1. Secure catheter with tape to prevent "pull"
2. Flush with 10ml syringe to prevent migration of catheter tip from subclavian to internal jugular vein
3. Teach patient to refrain from vigorous sports depending on type of catheter

1. Stop infusions
2. Reposition catheter

Perforation or Cardiac Tamponode

1. Catheter has curved tip via x-ray
2. Tachycardia, hypotension, muffled heart sounds, eventually no palpable pulses

1. Correct catheter tip placement so not lying in right ventricle
2. Securing catheter to prevent migration into right ventricle

1. Removal
2. Stop infusions
3. Supportive care

Air Emboli

1. Catheter open to air
   • cracked
   • not clamped when end open to air
2. Shortness of breath, chest pain, tachycardia, confusion, mechanical noise over precordium, hypotension, hemoptysis

1. If catheter cracked, clamp between exit site and crack (unless Groshong)
2. Repair catheter
3. If suspect air embolism:
   • clamp catheter
   • administer oxygen
   • place patient on left side with head down
   • Prepare for attempted aspiration of air

Catheter Occlusion; thrombosis/fibrin sheath

1. Unable to infuse or withdraw from catheter (thrombosis)
2. Able to infuse but unable to withdraw fluids (fibrin sheath)
3. Pain or discomfort in arm, shoulder or neck
4. Neck or shoulder edema
5. Sutures not pinching off catheter

1. Routine flushing and maintenance of positive pressure
2. Low dose anticoagulant therapy
3. Flush between drugs (precipitates may occlude catheter)
4. Avoid kinking catheter

1. Flush gently with normal saline using 10-20 ml syringe
2. Reposition patient
3. Cough and deep breath
4. Raise arm
5. If thrombus suspected infuse thrombolytic agent (strepto-kinase or urokinase) per agency protocol

Exit Site

1. Redness, drainage, edema or tenderness at exit site
2. WBCs at exit site may be elevated
3. Assess risk factors (TPN infusion, immuno-suppressed, etc.)

1. Strict handwashing
2. Aseptic technique
3. Follow dressing change protocol - change loose or contaminated dressings

    

4. Teach patient and family proper site care

1. Daily site care
2. Antibiotics

Tunnel

1. Redness, swelling, tenderness over tunnel
2. WBC's may be elevated
3. Assess risk factors

1. Proper site and catheter care

1. Blood culture
2. Parenteral antibiotics (difficulty is delivering
3. Removal of catheter

Systemic

1. Increase or decrease in body temperature
2. Chills, hypotension
3. Leukocytosis may be present

1. Proper site and catheter care
2. Prevention of thrombus formation (may be source of infection)

1. Parenteral antibiotics 10-14 days
2. Blood cultures
3. May have to remove catheter
4.