Dissection of the subclavian artery with mediastinal haemorrhage – an unusual complication of central venous catheterisation

Arterial cannulation is a recognised complication of attempted central venous cannulation. Arterial cannulation may cause haemorrhage, thrombosis, pseudoaneurysm formation, mycotic and true aneurysm formation and air embolism. We describe a case of subclavian artery dissection during attempted subclavian vein catheter placement resulting in a mediastinal haematoma and cardiac tamponade contributing to death. Inadvertent arterial cannulation may be difficult to diagnose in the hypoxic, hypotensive patient. The complications of arterial cannulation during attempted subclavian central venous catheter placement may be minimised by careful positioning, meticulous attention to technique and avoiding the use of large bore central venous catheters in unstable patients.