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LETTER
Placement of neonatal central venous catheter tips: is the right atrium so dangerous?
  1. D W Cartwright1
  1. 1Director of Neonatology, Royal Women’s Hospital, Brisbane, Australia; David_Cartwright@Health.qld.gov.au

https://doi.org/10.1136/fn.87.2.F155-a

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    The debate about placement of central venous catheter tips in neonates1 leaves me puzzled. We have been using percutaneously placed central venous catheters in our unit since 1978, with the aim of tip placement in the right atrium achieved in 58% of catheters. I have prospectively maintained records of every baby, their diagnoses, managements (including central venous catheter use), and complications treated here since 1983. These records cover the period 1 January 1984 to 31 December 2001 and encompass 2044 catheters placed in 1738 babies, for a total of 33 014 days. The longest life of any single catheter has been 99 days. I have never seen the complication of cardiac tamponade from one of these catheters. Why? Some may suggest we have “missed” it. I think not. I would suggest the following:

    1. All catheters are placed by experienced personnel, consultant or senior registrar.

    2. No catheter is ever left in a position where it does not easily and repeatedly withdraw blood.

    3. All catheters are injected with radio-opaque …

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