Subclavian catheterization using the peel away sheath.

The placement of percutaneous central venous catheters has become commonplace. Refinement of the technical details of the procedure should be directed toward the goals of increasing safety for the patient and facilitating the accurate positioning of the intravenous catheters. The method described achieves these therapeutic goals and may be used to insert several of the devices which are commercially available. With this method of catheter placement, the Seldinger technique of achieving vascular access is used. A medium bore needle is used to locate the desired vein and to position an intravascular guide wire. Tissue trauma is minimized, and finally, the introducer sheath may be removed prior to dressing placement. We have used the method for the placement of subclavian catheters in 50 patients. Catheter malposition occurred once. No patient had a technical complication of catheter insertion or catheter sepsis.