Anatomical basis of central venous catheter fracture

Department of Surgery, School of Medicine and Health Sciences, University of North Dakota, Veteran's Administration Medical Center, Fargo, North Dakota 58102, USA.
Clinical Anatomy (Impact Factor: 1.16). 03/2008; 21(2):106-10. DOI: 10.1002/ca.20605
Source: PubMed

ABSTRACT Central venous catheter fracture is a rare complication of long-term indwelling subclavian venous access. Subclavian vein access has been the recommended approach for placing central venous catheters. The anatomical landmark method for subclavian access remains a highly successful and nonequipment-dependent method for rapid central access. More recently, the internal jugular vein approach has emerged as the preferred route for long-term central venous access. However, variations in internal jugular vein anatomy make the landmark method less reliable. Use of two-dimensional real-time ultrasound during internal jugular vein access is associated with better success, a lower complication rate, and faster access. A case of central venous catheter fracture initiated an internal review of long-term central venous access procedures. We have converted to a predominantly internal jugular vein approach. This case report and literature review may assist other physicians and institutions in re-evaluating long-term central venous access protocols.

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