Placement of neonatal central venous catheter tips: is the right atrium so dangerous?

• central venous catheter
• long lines
• atrium
• heart

The debate about placement of central venous catheter tips in neonates¹ leaves me puzzled. We have been using percutaneously placed central venous catheters in our unit since 1978, with the aim of tip placement in the right atrium achieved in 58% of catheters. I have prospectively maintained records of every baby, their diagnoses, managements (including central venous catheter use), and complications treated here since 1983. These records cover the period 1 January 1984 to 31 December 2001 and encompass 2044 catheters placed in 1738 babies, for a total of 33 014 days. The longest life of any single catheter has been 99 days. I have never seen the complication of cardiac tamponade from one of these catheters. Why? Some may suggest we have “missed” it. I think not. I would suggest the following:

1. All catheters are placed by experienced personnel, consultant or senior registrar.

2. No catheter is ever left in a position where it does not easily and repeatedly withdraw blood.

3. All catheters are injected with radio-opaque …