Delayed pneumothorax: a complication of subclavian vein catheterization.

Subclavian catheterization is a reliable, well-described technique of central venous access for a variety of indications. Significant complications are associated with the procedure. Detection of the majority of complications is afforded by the postinsertion chest x-ray. Delayed pneumothorax, a relatively unrecognized complication of subclavian catheterization, is caused by a slow pleural air leak which appears to be associated with the "difficult" insertion as illustrated by three case reports. A repeat or "delayed" chest roentgenogram should be considered in the following situations: Difficult subclavian insertions requiring multiple attempts. Suspicion of pleural injury such as aspiration of air during insertion or subcutaneous emphysema with a normal postinsertion chest x-ray. The presence of another major complication. If the patient complains of persistent pleuritic or back pain after insertion. Preoperatively after previous difficult insertion of a central venous line. Postoperatively when a subclavian catheter is inserted intraoperatively.