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April 1, 1983

Fatal Cardiac Tamponade

JAMA. 1983;249(13):1707. doi:10.1001/jama.1983.03330370021009

To the Editor.—  The report by Drs Sheep and Guiney entitled "Fatal Cardiac Tamponade: Occurrence With Other Complications After Left Internal Jugular Vein Catheterization" (1982;428:1632) indicates one of the potential hazards of central venous catheterization and indwelling catheters. However, in a personal series of more than 9,000 central venous catheters since May 1968, I have not encountered this complication (6,000 semirigid polyethylene and 3,000 soft silicone).1,2 Based on this experience, I wish to outline some pertinent points that may help prevent similar complications.The pericardial tamponade is the result of the tip of the rigid catheter being positioned against the wall of the vein and motions of the heart having driven the tip through the wall of the vein. This complication can occur with a rigid catheter inserted through any vein as long as the tip is against the wall of the superior vena cava in the intrapericardial part.