Anesth Analg 2007;104:216-217
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ane.0000249837.89881.2d
LETTER TO THE EDITOR
Editor-in-Chief Steven L. Shafer
Central Landmark for Central Venous Catheterization
Peter Bailey, MD,
Emmett Whitaker, MD, and
Laurent Glance, MD
Department of Anesthesiology, University of Rochester, Rochester, New York, Peter_Bailey{at}URMC.Rochester.edu
In Response:
We would like to thank Drs. Ye, Zhu, and Liu for their comments (1). On the basis of the literature and our practice, we do recommend ultrasound (screening technique and/or real-time use) for all central venous catheterizations (CVC). However, our study neither determined nor concluded that ultrasound should be mandated for CVC (2). The para-carotid approach has the same limitations that all landmark "feel" or "blind" techniques have; they cannot discern variations in the size of the internal jugular vein or its relationship to the carotid artery. We also do not feel that a success rate of "over 93%" is necessarily sufficient. In most settings the desired outcome is 100% success with minimal or no complications and little to no delay. Waiting for failure of any approach to occur before using ultrasound seems illogical, as there is no risk associated with ultrasound. We believe that waiting to use ultrasound until difficulties have been encountered is likely to diminish its benefits. Interestingly, Dr. Ye et al. state that they find the literature ample to justify the use of ultrasound in children. The evidence supporting the use of ultrasound for CVC in adults is stronger than in pediatrics (3–12). Finally, recommending that clinicians who routinely obtain CVC via the right internal jugular vein should use the subclavian route in emergencies is an untested hypothesis. Clinicians are probably most successful in emergent situations, using the techniques they do most often.
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