Percutaneous subclavian vein catheterization. Too much of a good thing?

Eighty-one percutaneous subclavian vein catheterizations ( PSVCs ) were randomly selected for retrospective audits. Physicians with varied levels of experience were performing PSVCs in many patient care areas. The incidence of pneumothorax was 12.4%. After impersonal contacts by the audit committee failed to reduce that rate, a concurrent audit process with direct physician contact was initiated. This reduced the complication rate significantly. Because earlier published reports had associated PSVCs with low complication rates, operator caution may have given way to overzealous use by undertrained physicians. Direct physician involvement in quality-assurance programs can enhance patient care.