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This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Copyright (c) 2025 Shahir Asraf bin Abdul Rahim, Chu Chian Kok, Nurul Syuhada binti Suhaimi
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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.
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