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Iatrogenic pneumothorax after central venous catheter — SCE Acute Medicine MCQ

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ModerateProcedural KnowledgeIatrogenic pneumothorax after central venous catheterSCE Acute Medicine

A 36-year-old man with septic shock has a central venous catheter inserted. Immediately afterwards he develops pleuritic chest pain and hypoxia. Chest radiograph shows a large right pneumothorax without mediastinal shift. He is breathless but BP is 118/70 mmHg. What is the most appropriate next step in management?

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Correct answer: A — Insert a small-bore chest drain using safe pleural technique

A large symptomatic iatrogenic pneumothorax after central venous catheter insertion requires chest drain insertion. Needle decompression is for tension physiology as an emergency bridge, which is not present here. Observation is for selected small, minimally symptomatic pneumothoraces. The procedural lesson is to confirm complications promptly after central access and use safe pleural insertion landmarks.

Reference: BTS pleural disease guideline 2023, NPSA chest drain safety alert