Malposition of a Subclavian Line

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Abstract
THE USE of hyperosmolar intravenous solutions to provide positive nitrogen and calorie balance in patients unable to maintain adequate nutrition by conventional means has become a well-established clinical technique. Because of their hypertonicity, such solutions must be administered into an area of rapid blood flow with adequate mixing. This usually involves the placement of a central venous catheter. The metabolic and septic complications of total parenteral nutrition have been reviewed extensively. Complications of catheter placement have also been reported, including pneumothorax, pleural effusion, thrombophlebitis, brachial plexus injury, mediastinal hematoma, and carotid artery laceration. We recently encountered a complication that has not been reported in the literature, to our knowledge. This complication was manifested by pleural effusions, interstitial pulmonary edema, and chest wall abscess. It occurred because of catheter malposition undetected by the usual methods of confirming line placement. Report of a Case A 35-year-old woman was transferred to the Peter

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