Central line insertion is a commonly performed invasive procedure in intensive care units various access techniques and devices were developed for many indications, including total parenteral nutrition administration, dialysis, plasmapheresis, medication administration, and hemodynamic monitoring, and to facilitate further complex interventions such as transvenous pacemaker placement.{1-3} Although it is generally considered safe, it can be associated with various complications, including vascular injuries. Perforation of the internal mammary artery during central line insertion is an infrequent but potentially serious complication. {4-6}

A 67-year-old male with a history of diabetes, hypertension, pneumonitis, and sepsis underwent central line. The pre-procedural evaluation indicated stable vital signs and normal laboratory parameters. After the procedure, the patient rapidly developed signs of hemodynamic instability, including hypotension and tachycardia with severe dyspnoea. A chest X-ray revealed a right-sided hemothorax. He was immediately intubated and inotropes started. Chest tube insertion was done but there was fresh red blood was coming out. The interventional team was immediately notified, and the procedure was halted to address the emergent situation.

In response to the RIMA perforation, the interventional team rapidly initiated measures to control bleeding and stabilize the patient. A covered stent was carefully positioned to seal the perforation site, effectively controlling the bleeding. The patient received blood products to correct the hemodynamic compromise caused by the hemothorax.

Following successful intervention, the patient's condition stabilized, and his vital signs normalized. Serial chest X-rays showed resolution of the hemothorax over the next few days. He was kept under close monitoring in the cardiac care unit and showed no signs of further complications.

Perforation of the right internal mammary artery during central line insertion is a rare but potentially life-threatening complication. Prompt recognition, immediate intervention, and a skilled interventional team are crucial for managing this complication successfully. Interventionists performing central line insertion should be aware of this rare complication and be prepared to handle it effectively to ensure favourable patient outcomes. Vigilance during the procedure and close monitoring of patient’s post-intervention are essential to minimize the risk of such complications...

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