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LETTER TO THE EDITOR

Central Landmark for Central Venous Catheterization

Department of Anesthesiology and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China, zerodq_hx{at}163.com

To the Editor:

We agree with Bailey et al. (1) that the central landmark for right internal jugular cannulation has a medial bias, but this does not mandate ultrasound guidance for central catheterization. In our hospital we perform about 5000 cases of central venous catheterization every year. In adults we always use the para-carotid approach, even if the landmark is obscured by obesity. Our success rate is more than 93%. If the first needle fails to identify the internal jugular we consider ultrasound guidance. In children we usually use ultrasound guidance, which has been demonstrated to improve success (2–4). In emergencies our practice is to cannulate the subclavian vein, consistent with the suggestion by Abboud and Kendall (5) that the technique used depends on the clinical situation and equipment available.

REFERENCES

1. Bailey PL, Whitaker EE, Palmer LS, Glance LG. The accuracy of the central landmark used for central venous catheterization of the internal jugular vein. Anesth Analg 2006;102:1327–32.[Abstract/Free Full Text]
2. Leyvi G, Taylor DG, Reith E, Wasnick JD. Utility of ultrasound-guided central venous cannulation in pediatric surgical patients: a clinical series. Paediatr Anaesth 2005;15:953–8.[Medline]
3. Wei XC, Wei W, Li Y. A randomized-controlled study of ultrasound prelocation vs anatomical landmark-guided cannulation of the internal jugular vein in infants and children. Anesth Analg 2005;15:733–8.
4. Arai T, Yamashita M. Central venous catheterization in infants and children–small caliber audio-Doppler probe versus ultrasound scanner. Paediatr Anaesth 2005;15:858–61.[Medline]
5. Abboud PA, Kendall JL. Ultrasound guidance for vascular access. Emerg Med Clin North Am 2004;22:749–73.[Web of Science][Medline]

This article has been cited by other articles:

				P. Bailey, E. Whitaker, and L. Glance Central Landmark for Central Venous Catheterization Anesth. Analg., January 1, 2007; 104(1): 216 - 217. [Full Text] [PDF]

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