Complications of Invasive Procedures


  • In the intensive care setting, it is common to perform a variety of invasive procedures for aiding in both diagnosis and treatment. Unfortunately, such procedures are not without risk of complications. The following outlines the common complications associated with many of the invasive procedures performed in the critical care setting.

Endotracheal Intubation

  • Esophageal intubation
  • Mainstem bronchus intubation
  • Dental injury/damage
  • Aspiration
  • Vocal cord injury
  • Arytenoid injury
  • Hypoxia due to prolonged time for intubation
  • Ocular injury during laryngoscopy

Central Venous Catheterization

  • Complications vary with site and side of attempted cannulation
  • Atrial/ventricular arrhythmia
  • Arterial puncture
  • Pneumothorax/hemothorax/chylothorax
  • Air embolism
  • Tracheal injury
  • Infection
    • Higher infection rates with femoral site vs. internal jugular or subclavian
    • Bleeding/hematoma
      • Bleeding is difficult to control with the subclavian approach.
      • Check coagulation and platelet count labs prior to insertion if possible.
    • Vessel wall perforation/tear
    • Pain

Pulmonary Artery Catheter Placement

  • All complications due to central venous cannulation apply if inserting new CVC to facilitate PAC placement.
  • Arrhythmia
  • New-onset right bundle branch block
    • Use caution in patients with pre-existing left bundle branch block.
  • Knotting of the catheter
  • Valvular damage due to withdrawing PAC with balloon inflated
  • Chordae tendineae damage due to withdrawing PAC with balloon inflated
  • Pulmonary artery rupture
    • Mortality >30%
  • Pulmonary infarction

Arterial Cannulation

  • Brachial artery cannulation not recommended due to high complication rates; radial, axillary, or femoral sites preferred
  • Infection
  • Bleeding/hematoma
  • Nerve injury
  • Vessel occlusion
    • More common with radial artery compared to axillary, femoral artery
  • Limb ischemia from prolonged vessel occlusion
  • Pseudoaneurysm formation
  • Pain


  • Pneumothorax
  • Bleeding/hemothorax
  • Direct lung injury
  • Intercostal nerve injury
  • Infection/empyema
  • Re-expansion pulmonary edema
    • May occur if large volume of fluid is evacuated
  • Pain


  • Bowel injury/perforation
  • Vascular injury
  • Bleeding/hemorrhage
  • Bladder injury
  • Infection
  • Hypotension due to large-volume removal
  • Pain

Lumbar Puncture

  • Brain herniation
    • Ensure that patient does not have elevated ICP due to intracranial mass.
  • Nerve injury
  • Infection
  • Bleeding
  • Pain
  • Headache

Fiberoptic Bronchoscopy

  • Hypoxemia
    • Very common; always place patients on increased FiO2 (100% in intubated patients)
  • Bleeding
  • Arrhythmia
  • Bronchial tree injury
  • Pneumothorax
  • Bronchospasm/laryngospasm


  • Complication rates decreased if performed with echocardiographic guidance/visualization
  • Puncture of cardiac chambers
  • Coronary artery injury
  • Pneumothorax
  • Bowel injury/perforation
  • Infection
  • Pain

Chest Tube Placement

  • Direct lung injury
  • Cardiac chamber perforation
  • Abdominal organ injury due to inadvertent intra-abdominal placement
  • Diaphragmatic injury
  • Vascular perforation/bleeding
  • Infection/empyema
  • Horner’s syndrome due to compression of stellate ganglion
  • Nerve injury
    • Intercostal or long thoracic nerve
  • Pain

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Last updated: April 15, 2010