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Summary: Infraclavicular and supraclavicular approaches are used for subclavian venous catheterisation. We hypothesised that the supraclavicular approach is non‐inferior to the infraclavicular approach in terms of safety during ultrasound‐guided right subclavian venous catheterisation. We randomly allocated 401 neurosurgical patients undergoing ultrasound‐guided right subclavian venous catheterisation into supraclavicular (n = 200) and infraclavicular (n = 201) groups. We assessed catheterisation‐related complications (primary outcome measure) including catheter misplacement and mechanical complications (arterial puncture, haematoma formation, pneumothorax and haemothorax). We also recorded catheterisation success rates and time required for venous puncture and catheterisation. The number (proportion) of patients with catheterisation‐related complications was six (3.0%) in the supraclavicular group and 27 (13.4%) in the infraclavicular group, mean difference (95%CI) −10.4% (−15.7 to −5.1%), p < 0.001, with a significant difference also seen for catheter misplacement. Except for a shorter time (median (IQR [range]) required for venous puncture in the supraclavicular group, being 9 (6–20 [2–138]) vs. 13 (8–20 [3–99]) s, the incidence of mechanical complications and other catheterisation characteristics were similar between the two groups. We recommend the supraclavicular approach for ultrasound‐guided right subclavian venous catheterisation. [ABSTRACT FROM AUTHOR]

Summary We investigated the number and distribution of arteries within the brachial plexus territory using a portable ultrasound device, and compared these findings with known cadaveric data. We recruited 200 volunteers and carried out 400 brachial plexus examinations in a prospective observational study design. We identified arteries within the brachial plexus in more than 90% of subjects. Most of these were located in the upper and middle zones of the plexus and therefore lie within the possible path of a block needle. These findings correlate well with previous cadaveric studies, suggesting that arteries within the brachial plexus territory can be reliably identified with a portable ultrasound device. The presence of these vessels may impact upon the safety and efficacy of brachial plexus blockade. Routine pre-procedural sonographic assessment may offer improved safety and efficacy. You can respond to this article at [ABSTRACT FROM AUTHOR]

Comments on the article suggesting intermittent reinsertion of the stylet during approach to the epidural space using loss of resistance to air. Maneuvers to avoid accidental dural puncture; Replacement of the stylet.

Extravascular placement of a pulmonary artery catheter occurred when it was passed down an in situ sheath, the side arm of which had already been used for administration of fluids without any problems. The case emphasises that complications occur with the use of invasive monitoring and a correctly placed line may become extravascular even in a short time. [ABSTRACT FROM AUTHOR]

Discusses the effects of alterations in posture on cerebrospinal fluid (CSF) pressure. Increase in CSF pressure when patients moved from flexed to fully flexed position; Mean increase in CSF pressure when moving from lateral to the sitting position; Incidence of inadvertent dural puncture.

Responds to J.L. Shah's paper on the effects of altering posture on cerebrospinal fluid (CSF) pressure, published in the October 1998 issue of the periodical 'Anaesthesia.' Decrease in CSF pressure on moving from the fully flexed to the flexed position; Incidence of inadvertent dural puncture.