Since the subclavian is a low-pressure vein, the catheter may migrate into other closely associated veins or the right atrium.  Catheter migration can cause life-threatening complications such as perforation of the pleura, heart or great vessels, infiltration, myocardial irritation, pneumothorax, or hemothorax.

Assessment:

• Assess the patient for migration of the catheter to the internal jugular vein by monitoring for ear or neck pain on the side of placement and by asking the patient if they hear swishing or gurgling sounds
• Assess for migration of the catheter to the right atrium by assessing for palpitations and/or cardiac arrhythmias
• Assess for backflow of blood into the catheter unrelated to increased intrathoracic pressure.  This may be due to the migration of the catheter into the right atrium

Intervention:

• If you suspect the line is displaced, order a chest x-ray
• Confirm that a placement x-ray has been performed prior to initial use