The use of central venous cannulae in neuroanaesthesia. A survey of current practice in the UK.

A postal questionnaire was sent to all UK consultant members of the Neuroanaesthesia Society to ascertain whether there was any consensus on indications for use and route of insertion of central venous cannulae in elective neuroanaesthetic practice. Five brief clinical scenarios were presented. Of 179 respondents, 98% indicated that they would insert a central venous cannula into patients requiring excision of an acoustic neuroma in the sitting position, 76% for clipping of an intracranial aneurysm and 75% for resection of an arteriovenous malformation. The antecubital fossa was the preferred route of insertion for 43.5% of respondents with 36.5% preferring the internal jugular approach. The subclavian (17%) and femoral (3%) routes were unpopular first-choice approaches. A significant proportion of respondents (43.5%) do not routinely order a chest X-ray at any stage following pre-operative central venous cannulation. The indications for use and advantages and disadvantages of each route of insertion, with reference to neuro-anaesthetic practice, are discussed.