British Journal of Anaesthesia, 2000, Vol. 85, No. 2 188-191
© 2000 The Board of Management and Trustees of the British Journal of Anaesthesia
Editorial |
Editorial II
Safe placement of central venous catheters: where should the tip of the catheter lie?
Central venous catheters are ubiquitous in modern hospital and ambulatory medicine, with up to 6 million insertions per year in the USA1 and 200 000 per year in the UK.2 Despite this, there is still considerable doubt as to what constitutes optimal practice in terms of catheter composition, route of placement and the minimization of complications such as catheter-related sepsis, thrombosis and vessel perforation.
In this issue of the journal, Schuster and colleagues describe an elegant post-mortem, radiological study of pericardial anatomy.3 This work is based on the premise that, in order to prevent atrial or ventricular perforation and subsequent cardiac tamponade, the central venous catheter tip should not lie within the boundaries of the pericardial sac. In seeking to prevent this dramatic but rare complication are we exposing the patient to other equally serious but more insidious complications? The answer is probably yes. These issues are explored in this editorial.
Perforation
Thrombosis and catheter-related sepsis
Extravasation
Positioning
Conclusions
References
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