Venepuncture, catheterization and failure to position correctly during central venous cannulation

The authors analyse the incidence of puncture, catheterization and failures of positioning in a series of 420 central venous catheterizations performed in 388 patients, using six transcutaneous approaches: supraclavicular and infraclavicular subclavian, external and internal transjugular, antecubital and brachiocephalic. Puncture failures were recorded at 7.9% per 36 failures from 456 attempts, catheterization failures at 5.8% per 26 failures from 446 attempts, and misplacements at a rate of 5.7% per 23 misplacements during 420 catheterizations. The results show that, in respect of puncture, catheterization and success of positioning, the supraclavicular subclavian approach may be recommended preferentially. The internal jugular, brachiocephalic and infraclavicular subclavian approaches are also advantageous. A high rate of failures and misplacements was recorded in the antecubital and external jugular groups. The antecubital veins, however, should be reserved for orthopnoeic sitting patients, the success rate being significantly increased if the patients are sitting.