Canulating an artery seems to be so much more common with the subclavian
than with the internal jugular route. I cut my central line teeth on
subclavians rather than jugulars when I did a renal job for 6 months and
replaced central lines for haemodialysis access every day. Initialy
puncturing the subclavian artery was a common occurrence but the learning
curve meant this decreased. We used to apply pressure for a few minutes and
try again when we would be successful. I dont remember any horrendous
consequences and that was with a population who often had qualitatively
dysfunctional platelets. Having said that I recall reading a paper from an
American journal a few years ago about extracting a catheter from a
canulated subcalvian artery and thinking they had gone over the top so it
would'nt surprise me if you tell us he had a major procedure to extract the
catheter.
I guess we also have to think about the consequences of any procedure, and
would our management be the same in a 90 + year old pedestrian as it would
be with a 20 + year old. What age bracket was your patient in Simon ?
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