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 …