Home > Past Issue > Fulltext Wed, 10 May, 2006 Search   By Title By Author By any word Subscribers' Area   Activate your print subscription   New Subscriber   Renew   Claim   Update your account Contents   Current Issue   Past Issues   Forthcoming Author's Information   Instructions to authors   Copyright About JVA   Aims and scope   Editorial board   Staff   Terms and conditions   Permission form Advertising News and Events Feedback Links Info Journal of Vascular Access 2000; 1: 100 - 107 Which is the easiest and safest technique for central venous access? A retrospective survey of more than 5,400 cases M. Pittiruti1, M. Malerba2, C. Carriero3, L. Tazza3, D. Gui3 1Departments of Surgery and Oncology, Catholic University, Rome - Italy 2Department of surgery, Catholic University, Rome - Italy 3Department of Surgery, Catholic University, Rome - Italy Search Medline for articles by: M. Pittiruti M. Malerba C. Carriero L. Tazza D. Gui  Printable Format (PDF) ABSTRACT There is an ongoing debate on the technique for central venous catheterization associated with the lowest complication rate and the highest success rate. In an attempt to better define the easiest and safest venous approach, we have reviewed our 7-year experience with 5479 central venous percutaneous punctures (by Seldinger's technique) for the insertion of short-term (n=2109), medium/long-term (n=2627) catheters, as well as double-lumen, large-bore catheters for hemodialysis and/or hemapheresis (n=743). We have analyzed the incidence of the most frequent in-sertion-related complications by comparing seven different venous approaches: jugular vein, low lateral approach; jugular vein, high lateral approach; jugular vein, low axial approach; subclavian vein, infraclavicular approach; subclavian vein, supraclavicular approach; external jugular vein; femoral vein. The results of our retrospective study suggest that the 'low lateral' approach to the internal jugular vein, as described by Jernigan and modified according to our protocol, appears to be the easiest and safest technique for percutaneous insertion of central venous access, being characterized by the lowest incidence of accidental arte-rial puncture (1.2%) and malposition (0.8%), no pneumothorax, and an extremely low rate of repeated attempts (i.e. more than two punctures before successful cannulation) (3.3%). We advocate the 'low lateral' approach to the internal jugular vein as first-choice technique for venipuncture in both adults and children, for both short-term and long-term central venous percutaneous cannulation. Key Words. Central venous catheterization, Jugular vein , Subclavian vein, Pneumothorax, Malposition, Venipuncture null REFERENCES The Journal of Vascular Access - published and copyrighted by Wichtig Editore - Milano (Italy) Autorizzazione n. 788 del 16.12.1999 reg. tribunale di Milano - Direttore Responsabile Diego Brancaccio - ISSN 1724-6032