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To the Editor.—
The recent article by Dronen et al (1982;247:3227) demonstrated an increasing change in the approach to central venous catheterization. In 1981,I started a prospective study of complications from the infraclavicular (IC) approach to the subclavian vein during cardiopulmonary resuscitation (CPR) in our emergency department (60,000 annual visits). Full-time emergency physician staffing began coincident with the inception of that study, and the middle approach to the internal jugular vein was demonstrated to the house staff. Internal jugular and supraclavicular (SC) subclavian vein procedures rapidly replaced the IC approach in emergency situations. The study was abandoned after collecting only 12 cases in six months for the IC approach.At present, in our institution, the IC approach is used on an elective basis and by a few physicians not yet comfortable with the SC procedures. The relative ease of insertion and the lack of complications noted by the authors are
Mitchell GW. Central Venous Catheterization. JAMA. 1982;248(21):2836. doi:10.1001/jama.1982.03330210028021