The incidence of insertion complications declines with increasing experience of the clinician. It is important to remember that in patients with trauma, a coexistent unilateral hemopneumothorax may already be present. Thus, attempts at cannulation of the contralateral subclavian vein may result in fatal bilateral pneumothoraces. This can also occur following previous open-heart or mediastinal surgery when a communication may have been created between each pleural cavity similar to the anatomy of the 'buffalo' thorax; injury to the pleura in such cases results in bilateral lung collapse. Tab.l§...2. lists reported immediate complications of central venous catheterization.

Table 2 Reported immediate complications of central venous catheterization

The true incidence of such events is unknown. It would seem sensible and prudent in the future to use ultrasound-guided vascular access techniques ( Peters et al..

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