Backflow in Venous Cannulation

Arch Surg. 1984;119(7):866. doi:10.1001/archsurg.1984.01390190102026.
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To the Editor.—The article on subclavian vein cannulation by Conces and Holden1 was interesting and informative. However, although a comprehensive discussion was proffered, their main thrust was to promote reliance on the roentgenogram for correct catheter placement. While radiologic confirmation of correct catheter placement indisputably is important, the chief emphasis must remain on the demonstration of simple free siphon return of blood at the time of placement and after infusion of a small volume of conventional fluids; thereby, cannulation of a large vein is ascertained and the likelihood of catastrophe while awaiting the performance of a roentgenogram disappears.

As a junior resident, I recall assuming duty from a fellow resident who asked me to initiate hyperalimentation through a subclavian vein catheter he had placed. He told me to simply "check the chest x-ray" and direct the administration of the hyperalimentation fluids. He was irritated that I inquired after


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