SG - Non-inquest findings

68y · Female·Haemorrhage secondary to right subclavian artery lacerations sustained during central venous catheter insertion

A 68-year-old woman died from massive blood loss following inadvertent puncture of the right subclavian artery during central venous line insertion. The anaesthetist used anatomical landmarks without ultrasound after an initial high approach failed. Upon recognising arterial puncture, appropriate escalation occurred with vascular surgery involvement and emergency surgical exploration and repair. However, the subclavian artery location prevented adequate manual pressure control. The patient arrested during neck exploration and despite sternotomy and vascular repair, died from hypovolemic shock and subsequent cardiac compromise. The expert review found the clinical decision-making appropriate throughout. Key learning: ultrasound-guided central line insertion is now best practice and reduces but does not eliminate arterial puncture risk; recognition and prompt escalation were exemplary; subclavian artery punctures cannot be managed by neck pressure alone and require immediate vascular surgery.