To the Editor
The commentary of Dr. Bakalaw in the Summer 1990 issue of the Anesthesia Patient Safety Foundation Newsletter related to the “Central Venous Safety Guidelines” issued by the Food and Drug Administration Central Venous Catheter Marketing Group raises interesting issues. As the ASA representative to the group, I feel strongly that if a clinician thinks it is in the best interest of & patient to place a catheter tip in the right atrium, then he should do so. There is no consensus about the best position of the catheter tip for aspirations of air; some advocate placing the tip above the right atrium.
Since infections are common, wearing a gown seems to be a reasonable precaution. While it surely won’t prevent infection by itself, it helps to reduce sites from contamination and to raise awarenss that placing a central venous or pulmonary artery catheter is as invasive as many a surgical procedure. A general approach to providing care that abides by the highest practical level of sterility, I think, is what drove the group to suggest gowns.
The working group has worked to promote safety on other fronts. At present, we are producing a video tape on avoiding complications with central venous catheters.
David A. Paulus, M.D. Associate Professor of Anesthesiology and Mechanical Engineering, University of Florida, Gainesville