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To the Editor.—
Central venous pressure monitoring has remained a valuable adjunct to the treatment of seriously ill patients. In addition, a catheter placed in the central venous pool serves as an excellent input for intravenous fluid therapy. Of the various techniques for placement of a central venous catheter, the subclavian route is the most popular. Initially, the complications associated with subclavian puncture were infrequent, as the technique was only performed by those trained and skilled in its usage. Recently subclavian puncture has become so commonplace that the old adage "see one, do one, teach one" has never reached such heights (or depths.)The first major complication was pneumothorax and in the best hands an incidence of 1% to 2% was reported. However, if one reviews subsequent reports it is evident that many serious and occasionally fatal complications have resulted from the indiscriminate use of this procedure.Among the more
Goldman LI, Maier WP, Drezner AD, Rosemond GP. Another Complication of Subclavian Puncture: Arterial Laceration. JAMA. 1971;217(1):78. doi:10.1001/jama.1971.03190010060018