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Fatal complications of central venous catheters.

The use of central venous catheters has become indispensable in the management of severely ill and injured patients. Their main use is in central venous pressure monitoring, rapid infusion of fluids, and intravenous hyperalimentation. Regardless of the route of insertion of the central venous catheter, complications arise from injury to the vein wall or neighbouring structures, from thromboembolism and sepsis, and from air and catheter embolism. Most of these are not serious, but fatal complications have been reported by Schapira and Stern (1967), Friedman and Jurgeleit (1968), Flannagan et al. (1969), Thomas et al. (1969), and Raffensperger and Ramenofsky (1970). During a two-year period ending 31 December 1970, 141 patients had central venous catheters inserted while on a surgical ward of 36 beds. The catheter was inserted prophylactically for monitoring central venous pressure during 94 major operations. In 45 patients it was inserted in the course of resuscitation from shock, and in two patients it was utilized for intravenous hyperalimentation. The cases of two patients who died from the use of a central venous catheter are reported here.