title: Difficult access problems.
abstract: We have described numerous alternatives for establishing central venous access in challenging patients. Using these techniques has proven successful in our experience in essentially all patients, although occasionally initial efforts fail and repeated attempts by alternate routes are required. The keys to eventual success appear to be good basic surgical skills, a strong working relationship between surgeon and interventional radiologist, and perhaps most important, perseverance in the face of frustration.
authors.affiliation: Hospital of the University of Pennsylvania, Philadelphia, USA.
authors.forename: R C
authors.initials: RC
authors.lastname: Gorman
authors.forename: G P
authors.initials: GP
authors.lastname: Buzby
mesh_terms: D002405:Catheterization, Central Venous / Q000379:methods*; D006801:Humans; D016748:Venous Cutdown