DOI: https://doi.org/10.36347/sjmcr.2025.v13i11.026

Pages: 2779-2782

Central venous catheter (CVC) insertion is essential for critically ill patients but entails risks, delayed venous perforation which is rare and can be fatal. This complication is difficult to detect early as clinical manifestations such as fever or dyspnea may appear late. We report a case of delayed venous perforation diagnosed by parenteral nutrition fluid drainage through a chest tube. A 72-year-old man underwent ultrasound-guided CVC insertion through the right subclavian vein with infraclavicular approach for scheduled right hepatectomy. A pneumothorax occurred during CVC insertion, for which a chest tube was placed. The chest radiograph obtained at that time demonstrated appropriate CVC position. On postoperative day 2, milky fluid drained from the chest tube after parenteral nutrition was started. A chest computed tomography confirmed the CVC tip had perforated the venous wall at the junction of Superior vena cava and innominate vein, extending into the mediastinum. The CVC was immediately removed, and the patient recovered uneventfully with antibiotics. Clinicians must maintain vigilance during follow-up. Any unexpected radiographic change in catheter tip position or failure to aspirate blood should prompt concern for delayed perforation and immediate preventive action