Inadvertent subclavian arterial central line insertion in the multi-trauma patient—A route to avoid?

SummaryCentral venous access is often required in multiply injured patients either in the initial resuscitation phase, during an anaesthetic for surgical procedures or during an ICU stay. There are potential complications with all attempts at central access and these can be compounded in the trauma patient. Traditional teaching has been that attempts at central cannulation are preferred on the same side as a chest injury to reduce the chances of a bilateral pneumothorax caused by accidental pleural puncture. The subclavian site also has traditional advantages in the immobilized patient with a suspected neck injury. We report a case of inadvertent subclavian arterial puncture in a shocked trauma patient with chest injuries. We review the rationale behind insertion site options with such patients and discuss the traditional approach to central line insertion in polytrauma patients.