See Table 6.1. The procedure is usually associated with a low complication rate and most are minor, such as bruising, difficulty gaining access to the vein, and minor superficial infection. Major complications are rare, but can occur, such as pneumothorax, which may require further hospitalization or insertion of an underwater-seal chest drain tube. Cardiac arrhythmias and bleeding are risks during insertion. Immediate withdrawal of the catheter wire or tube several centimeters will usually settle the arrhythmia. Catheter thrombosis, cardiac arrhythmias, and migration of the catheter are also potentially serious as the catheter may require removal and later reinsertion. Percutaneous CVC lines invariably fail over time due to infection, mechanical problems, or thrombosis, and regular replacement may avert these issues as clinical complications. Failure to complete the procedure by the percutaneous method will not usually disallow its insertion, since the open approach can then usually be safely used. Bilateral attempts at central line insertion via the subclavian approach at the same operation are not advisable within 24 h, as there is a risk of inducing bilateral pneumothoraces. Use of the internal jugular approach is preferable after a failed subclavian approach.

The main severe acute complications are pneumothorax, cardiac arrhythmias, air embolism, and hemothorax. Later, infection of the catheter line can lead to systemic sepsis and even multisystem organ failure, which is the major cause of mortality, especially in immunocompromised patients and severely ill patients. Removal of the central line invariably follows infection. Air embolism and hemothorax are very rare but can be life threatening. Catheter blockage or leakage due to a variety of problems, usually later, may require removal and reinsertion or adjustment. Catheter thrombosis and pulmonary embolism can occur and may be serious. Axillary, subclavian, internal jugular, or superior vena cava venous thrombosis can cause severe swelling of the arm, neck, head, and chest. Carotid artery puncture is minimized by the use of ultrasound guidance. Cardiac arrhythmias are usually terminated by withdrawal of the guide wire from the heart chamber, usually the atrium affecting the sinoatrial node.