Central venous catheter placement for intravenous digital subtraction angiography: an assessment of technical problems and success rate

Scant attention has been paid to the technical aspects of central venous catheter placement in intravenous digital subtraction angiography (IV-DSA). In a prospective study of 200 unselected patients referred for IV-DSA, technical problems and success rates were recorded. Central venous access via an arm vein was achieved in 95% of patients. In 83% of cases, only one venous puncture was required. The commonest single cause for failure was being unable to find, puncture or introduce a guidewire into a suitable calibre vein at the cubital fossa in the first instance. Once entered with a guidewire, the median cubital/basilic route led to successful catheter passage to the superior vena cava (SVC) on 93% of occasions. The equivalent figure for the cephalic route was 80%. Only two out of 129 attempts at which the cephalic vein was entered failed as a result of being unable to negotiate the cephalic/axillary junction. Venous spasm and branch points in the arm were the main problems when using the cephalic vein and these together were responsible for the differences in success rate between the cephalic and basilic routes. The results indicate that in the clear majority of patients referred for IV-DSA, central venous catheter placement is straightforward. The median cubital/basilic route is preferred but even if the cephalic route has to be used, it should still provide access to the SVC in more than three-quarters of cases. Manoeuvres used to overcome access difficulties are discussed and illustrated.