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We appreciate Dr Parsa's comments on the pathogenesis of perforation with venous catheterization and indwelling catheters. His impressive personal series without vessel perforation is admirable.We are grateful to Dr Merrill for pointing out that not all guide wires employed in the Seldinger technique are flexible at both ends. Their report of venous perforation during insertion of a dialysis catheter is instructive in the potential hazards of central venous catheterization.As we state in our article, perforation may occur during catheter insertion or at some later time. Clinical alertness to the possibility of perforation is, therefore, necessary during the entire period of use of central venous catheters.
William B. Guiney, Robert E. Sheep. Fatal Cardiac Tamponade-Reply. JAMA. 1983;249(13):1707. doi:10.1001/jama.1983.03330370021011