Direct cephalic vein cannulation for safe subclavian access.

Over a 2-year period we have successfully inserted 70 subclavian catheters in 68 patients from 76 attempts by cephalic vein cutdown. There were no complications of catheter insertion although 40% were inserted by junior surgeons (mean survival of catheters was 16.5 days) and in 30% of patients the catheter was removed before the completion of treatment for both infective and other complications. From our results, we recommend that direct cephalic vein cutdown is the route of choice for elective subclavian access because of its safety.