Skip to main content

The cephalic vein catheterization: maybe yes, but when there is no alternative

The Original Article was published on 08 June 2022

Dear Editor,

We read with interest the paper entitled ‘Central venous catheterization: the cephalic vein access’ published in Critical Care [1]. The authors describe a patient who needed central venous cannula exchange for vasopressor administration and invasive hemodynamic monitoring. Therefore, they performed a cephalic vein catheterization.

The presented case report is surprising for a number of reasons. First, the patient already had a central venous cannula inserted via supraclavicular route, so the justification given for the catheter exchange is unclear. Second, the right cephalic vein, chosen for the operation, is 0.28 cm in diameter. As we know, inserted vascular catheters should not exceed 45% of the cross-sectional area of the cannulated vein due to the high risk of thrombotic complications [2]. This means that catheter diameter the authors used should not have exceeded 0.12 cm. However, the inserted catheter shown in Fig. 1 is much far larger [1]. Unfortunately, the authors did not mention this important issue. Third, the readers are not informed why other potentially accessible central veins were not chosen for catheterization (right internal jugular vein or left axillary vein). This is confusing since the right axillary vein presented on the ultrasound image (Fig. 1) seems as if it would have been very convenient for ultrasound-guided catheterization [1]. Four, the cannulated patient was defined as ‘obese,’ and the authors recommend this technique for consideration in morbidly obese patients. However, the body mass index in this case was 28, so the patient should be classified as ‘overweight’ [3].

In our opinion, the case described a unique rescue procedure rather than a reasonable approach for central vein catheterization. Based on this paper, this technique should be perceived strictly as a temporary solution which can be applied only if other central veins are inaccessible.

Availability of data and materials

Not applicable.

References

  1. Jiang S, Shen Y, Zhao X. Central venous catheterization: the cephalic vein access. Crit Care. 2022;26:169.

    Article  Google Scholar 

  2. Spencer TR, Mahoney KJ. Reducing catheter-related thrombosis using a risk reduction tool centered on catheter to vessel ratio. J Thromb Thrombolysis. 2017;44:427–34.

    Article  Google Scholar 

  3. Romero-Corral A, Somers VK, Sierra-Johnson J, Thomas RJ, Collazo-Clavell ML, Korinek J, et al. Accuracy of body mass index in diagnosing obesity in the adult general population. Int J Obes. 2008;32:959–66.

    Article  CAS  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

Authors

Contributions

RG prepared original draft. RG revised version of the manuscript preparation. RG and TC revised final version of the manuscript. RG and TC provided final approval of the revised manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ryszard Gawda.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Gawda, R., Czarnik, T. The cephalic vein catheterization: maybe yes, but when there is no alternative. Crit Care 27, 27 (2023). https://doi.org/10.1186/s13054-023-04321-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s13054-023-04321-z