Massive haemothorax from inadvertent subclavian vein injury during tunnelled dialysis catheter insertion requiring surgical repair

Abdul Rahim, Shahir Asraf and Kok, Chu Chian and Suhaimi, Nurul Syuhada (2025) Massive haemothorax from inadvertent subclavian vein injury during tunnelled dialysis catheter insertion requiring surgical repair. Malaysian Journal of Anaesthesiology (MyJA), 4 (2). pp. 177-184. ISSN 2772-9524 E-ISSN 2949-7787

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Abstract

Massive haemothorax is a rare but life-threatening complication of internal jugular vein catheterisation. We report a 55-year-old male with end-stage renal failure and limited intravascular access who required a tunnelled dialysis catheter after fistula failure and missed haemodialysis. Multiple ultrasound-guided insertion attempts resulted in an inadvertent massive left haemothorax. The patient developed immediate postprocedural respiratory distress, requiring intensive care unit (ICU) admission, mechanical ventilation, and vasopressor support. Computed tomography of the thorax confirmed left sided haemothorax, and an ultrasound-guided chest tube was inserted. It drained 700 mL of blood. He received transfusion of 4 units each of packed red blood cells, fresh frozen plasma, cryoprecipitate, and platelets. After stabilisation, he was transferred urgently to a tertiary hospital for cardiothoracic surgery. Thoracotomy revealed subclavian vein injury, which was repaired with an estimated intraoperative blood loss of 1.8 L. Postoperatively, he was successfully weaned from mechanical ventilation over 4 days in ICU. Early recognition of this rare complication and timely definitive intervention is essential to improving outcomes and ensuring patient safety

Item Type:	Article (Case Report)
Uncontrolled Keywords:	central venous catheter, inadvertent vascular injury, massive haemothorax
Subjects:	R Medicine > R Medicine (General)
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button):	Kulliyyah of Medicine > Department of Anaesthesiology & Intensive Care
Depositing User:	DR SHAHIR RAHIM
Date Deposited:	17 Jul 2026 16:59
Last Update:	17 Jul 2026 16:59
Queue Number:	2026-07-Q4089
URI:	http://irep.iium.edu.my/id/eprint/129965

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