Letters

Problems with temporary cardiac pacing

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7329.112 (Published 12 January 2002) Cite this as: BMJ 2002;324:112

Ultrasonography can aid central venous cannulation

  1. Paul Jefferson, consultant in anaesthesia and intensive care medicine ([email protected]),
  2. Vincent Perkins, consultant in anaesthesia and intensive care medicine
  1. Dumfries and Galloway Royal Infirmary, Dumfries DG1 4AP
  2. Royal Bournemouth Hospital, Bourenmouth BH7 7DW
  3. Department of Anaesthetics, Worcester Royal Infirmary, Worcester WR5 1HN
  4. Department of Respiratory Medicine, Thomas Guy House, Guy's Hospital, London SE1 9RT
  5. Department of Physiological Medicine, St George's Hospital Medical School, London SW17 0RE
  6. Northampton General Hospital, Northampton NN1 5BD

    EDITOR—Murphy in his editorial highlights problems with temporary cardiac pacing where the service is provided by doctors in training with inadequate supervision.1 An essential component of temporary pacing is obtaining central venous access. The failure rate for this intervention remains notable. Murphy suggests involving anaesthetists or intensivists to help resolve this problem.

    There are other ways to address this important issue rather than increasing the workload of another department. The first would be to increase the involvement of consultant physicians from the current level of only 14%. Failure rates for central venous cannulation are related to the experience of the operator, with failure rates almost double in inexperienced hands.2

    The second is to move from a landmark guided technique for central venous cannulation to an ultrasound guided technique. A meta-analysis comparing ultrasound guidance with a landmark technique for central venous cannulation suggested that ultrasound guidance significantly reduced the rates of failures and complications and the need for multiple attempts at placement.3 The benefits may be more obvious in patients with difficult central venous access.4

    References

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    Better training in general medicine is required

    1. Tristan Richardson, specialist registrar ([email protected])
    1. Dumfries and Galloway Royal Infirmary, Dumfries DG1 4AP
    2. Royal Bournemouth Hospital, Bourenmouth BH7 7DW
    3. Department of Anaesthetics, Worcester Royal Infirmary, Worcester WR5 1HN
    4. Department of Respiratory Medicine, Thomas Guy House, Guy's Hospital, London SE1 9RT
    5. Department of Physiological Medicine, St George's Hospital Medical School, London SW17 0RE
    6. Northampton General Hospital, Northampton NN1 5BD

      EDITOR—Temporary transvenous cardiac pacing is a life saving procedure and an important skill for emergency physicians to have.1 It is often a poorly taught procedure with potentially life threatening complications. It should not be embarked on without due care, attention, and training. When possible, waiting and observing more stable patients overnight until the permanent pacemaker list is much more desirable. But potentially deskilling the frontline may have equally disastrous consequences, as would transferring potentially unstable patients to other centres.

      If trainees in general medicine are not to expected to perform temporary pacing, then should the same be said …

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