BMJ 1995;311:1091 (21 October)

Letters

Operating theatre is better back up than venography

EDITOR,--Andy Adam asserts that interventional radiologists are the most appropriate specialists to insert long term venous catheters.1 He does not, however, provide any evidence that such a practice would benefit patients or provide an improved service. As a surgeon responsible for over 400 procedures to gain central venous access annually, I remain unconvinced of the benefits that Adam maintains accompany venography to provide "initial diagnostic information." Rather than simplifying the insertion of central venous catheters, this must surely constitute an additional complicating step.

In my practice over 95% of Hickman catheters are introduced by the percutaneous technique, with puncture of the subclavian vein performed blind. The anatomy of the subclavian vein in relation to the mid-third of the clavicle is remarkably constant, and I have been aware of inadvertent arterial puncture on only three occasions, with no subsequent morbidity. The use of an image intensifier to confirm placement of the . . . [Full text of this article]


Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to StumbleUpon StumbleUpon   Add to Technorati Technorati    What's this?

Relevant Article

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

Access jobs at BMJ Careers
Whats new online at Student BMJ