BMJ 1995;311:1090 (21 October)

Letters

Inserting central venous catheters

Case for angiographically guided placement is not proved

EDITOR,--Andy Adam's editorial suggesting that long term central venous catheters (Hickman lines) should be placed only by interventional radiologists contains many errors that seriously weaken his argument.1 His description of "traditional" surgical placement is incorrect: the lines are placed into the internal jugular vein or, less commonly, the cephalic vein and not, as he suggests, into the subclavian vein. The risks of arterial puncture in patients with coagulopathies is overstated, simply because coagulopathies should always be corrected before insertion of a central venous catheter, and the use of imaging does not exempt the operator from this requirement.

Adam states that the rate of arterial puncture is reduced when imaging is used. This is offset by the observation that the only death associated with placement of a catheter in one of the series that Adam cites in which catheters were placed by interventional . . . [Full text of this article]


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Relevant Article

Insertion of long term central venous catheters: time for a new look
Andy Adam
BMJ 1995 311: 341-342. [Extract] [Full Text]

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