Abstract
Background: Central venous catheterization (CVC) is a frequently performed procedure in anesthesia and critical care settings. Modern procedures have improved significantly, particularly with increasingly sophisticated venous verification methods and ultrasound guidance. While the associated historical complication rates reflect this improvement, complications such as inadvertent arterial puncture, arterial cannulation, pneumothorax, deep vein thrombosis, and catheter-associated infection are still significant risks. Methods: This narrative review was constructed from a literature review using a search strategy of the MESH terms central venous access, central venous line, complications, insertion, and puncture, published between 2015 and 2025. Inclusion criteria included peer-reviewed full-text articles. Supplementary articles were included to construct the historical perspectives on central venous access and complications. Results: Our review offers a simple management algorithm for the mechanical complications of CVC insertion. This algorithm focuses on inadvertent arterial puncture/cannulation, with steps ranging from external compression to endovascular repair or surgical intervention. Conclusions: Moving forward, clinicians are encouraged to look into the future to predict what complications may arise as our modern patient cohort evolves. When complications develop, clinicians should know how to manage them to prevent further patient morbidity.