Central vein catheterization. Failure and complication rates by three percutaneous approaches.

We prospectively studied the results of 714 attempts at central venous catheterization during an eight-month period in our intensive care department. We compared the rates of failure of catheterization and early complications among three percutaneous approaches: subclavian, anterior jugular, and posterior jugular veins. The procedures were performed by experienced staff or resident physicians and inexperienced interns and residents under teaching supervision. Overall rates of failure and complication were similar for each percutaneous approach within each group of physicians. Overall failure rate was 10.1% for the experienced group and 19.4% for the inexperienced. The complication was 5.4% for experienced and 11% for inexperienced. Among inexperienced physicians, the success rate was 86.7% and the complication rate 7.6% in unconscious patients, whereas in conscious patients these rates were 70.5% and 13.8%, respectively. The inexperienced physicians caused fewer complications in mechanically ventilated than in spontaneously breathing patients. We suggest that inexperienced physicians should first attempt central vein catheterizations in unconscious and mechanically ventilated patients.

Accidental intra-arterial injection of ketamine.

A case of accidental intra-arterial injection of ketamine is reported. Necrosis of the skin proximal to the site of injection and transient foot drop followed the injection.

Massive aspiration during surgery for a hydatid cyst of the lung.

A case of massive aspiration of hydatid liquid during an operation for excision of hydatid cyst of the lung is presented. Some considerations about the treatment and the anaesthetic approach to the problem are given. An analysis of 42 operations performed during 1963-1973 in the Rambam Hospital is discussed. Rupture of cyst with cyanosis and fall in blood pressure occurred in only 5 of these cases and among them, only one patient died.