Immediate hemothorax following subclavian central venous catheter removal: a case report.

Background: Central venous catheters play a vital role in managing critically ill patients by providing reliable access for fluid resuscitation, medication delivery, hemodialysis, and hemodynamic monitoring. While insertion-related complications such as pneumothorax and vascular injury are well described, adverse events following catheter removal are less commonly recognized in clinical practice. These post-removal complications, though rare, can be life-threatening if not promptly identified. This report presents a rare case of hemothorax occurring immediately after the removal of a subclavian central venous catheter that was previously inserted for hemodialysis in a recently established hospital in a developing country.

Case presentation: A 30-year-old Ethiopian female patient with chronic kidney disease and hypertension, undergoing hemodialysis via a right subclavian venous catheter for the past 2 weeks, presented with difficulty initiating dialysis during her fourth session. upon the suspicion of catheter malfunction, the central line was removed. Then, 20 minutes later, the patient developed shortness of breath, right-sided pleuritic chest pain, and a drop in blood pressure. Physical examination revealed absent air entry over the right lung field. Chest x-ray confirmed a right hemothorax, and hemoglobin decreased from 6.5 mg/dL to 5.1 mg/dL within 4 hours. A chest drain was inserted, evacuating 700 mL of blood. Following blood transfusions, the patient's condition stabilized, and the chest tube was removed on day 8 after nearly complete hemothorax resolution. The patient was discharged on day 9 with significant improvement.

Conclusion: This case highlights the potential for complications to arise not only during central venous catheter insertion but also during removal. Clinicians should ensure proper catheter positioning during insertion and implement post-removal monitoring protocols to detect rare but potentially life-threatening complications such as hemothorax.