title: Anatomical basis of central venous catheter fracture.
abstract: Central venous catheter fracture is a rare complication of long-term indwelling subclavian venous access. Subclavian vein access has been the recommended approach for placing central venous catheters. The anatomical landmark method for subclavian access remains a highly successful and nonequipment-dependent method for rapid central access. More recently, the internal jugular vein approach has emerged as the preferred route for long-term central venous access. However, variations in internal jugular vein anatomy make the landmark method less reliable. Use of two-dimensional real-time ultrasound during internal jugular vein access is associated with better success, a lower complication rate, and faster access. A case of central venous catheter fracture initiated an internal review of long-term central venous access procedures. We have converted to a predominantly internal jugular vein approach. This case report and literature review may assist other physicians and institutions in re-evaluating long-term central venous access protocols.
authors.affiliation: Department of Surgery, School of Medicine and Health Sciences, University of North Dakota, Veteran's Administration Medical Center, Fargo, North Dakota 58102, USA. mark_jensen@und.nodak.edu
authors.forename: Mark O
authors.initials: MO
authors.lastname: Jensen
mesh_terms: D000368:Aged; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D004868:Equipment Failure; D005547:Foreign Bodies / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D007601:Jugular Veins / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000293:injuries / Q000473:pathology; D013902:Radiography, Thoracic; D013350:Subclavian Vein / Q000000981:diagnostic imaging / Q000473:pathology*; D018084:Ultrasonography, Interventional / Q000379:methods