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Central venous catheters are usually positioned using the Seldinger technique with a guidewire. This article reports a case where the guidewire was inserted via the left subclavian vein with the landmark technique. The guidewire became kinked, pierced the vessel wall and became stuck forming several loops within the adjacent tissue of the vein. Several attempts were made to remove the guidewire by interventional radiology but were unsuccessful. Due to the critical condition of the patient an operation was considered too perilous and the guidewire was finally left in situ. No formation of local venous thrombosis could be detected.

In the case presented an intravenous line for large volume infusion rates was to be placed in a patient with an aortic aneurysm during clinical preoperative care. After a high-flow catheter had been placed without any problems retraction of the guide wire was found to be impossible. Computer tomography revealed that the reason was a kink in the catheter resulting in the guide wire being nipped off. Fortunately both catheter and guide wire could be removed completely without any further complications.

The necessity for insertion of a thorax drainage can lead to serious complications. Especially the use of a trocar instead of a mini-thoracotomy has a notable risk of misplacement or complications. Chest tubes per se can perforate the parietal pleura resulting in an extrathoracic position of the tube and contraindications for chest tubes should always be considered. Accidental lacerations of blood vessels should be avoided by a correct technique and a clear indication. A chest X-ray in one plane is not sufficient to prove correct positioning of a chest tube and suspected misplacement of a chest tube has to be assessed radiographically in at least two planes. A case of a fatal complication of a misplaced chest tube causing a laceration of the right subclavian vein is described.

The introduction of a reliable technique for nerve transplantation and the development of microsurgical neurolysis have made it possible to improve the degree of functional restoration that can be achieved following post-traumatic lesions of the brachial plexus. Although the functional recovery achieved still leaves a great deal to be desired, it is possible to reach a level of functioning that is beneficial for the patient. It is essential for the initial treatment plan to take account of both surgical reconstruction in the region of the brachial plexus itself and subsequent improvement of function by means of appropriate palliation.

This article reports the case of a patient who sustained an injury of the intercostal artery after a vena subclavia aspiration with extensive haemothorax. After thoracotomy, haemostatic treatment, respiratory therapy, intensive care and a prolonged hospital stay the female patient was discharged with a clean bill of health.

Report on 2 cases of transient phrenic nerve paresis respectively stationary brachial plexus paresis secondary to percutaneous subclavian venipuncture. In retrospect, the disregard of unfavourable anatomical conditions at the site of venipuncture was an important pathogenic factor for this neurological complications.