To the Editor.—We read with interest the report by van Haeften et al1 in the July 1988 issue of the Archives. The awareness of this unusual complication and the recommendations made by the authors will, hopefully, prevent similar events from going unrecognized.
Although they stated that the late occurrence (6 days after central line placement) of the tamponade was a "peculiar aspect" of the case, it is not uncommon. A review by Karnauchow2 of 49 cases of cardiac tamponade from central venous catheterization revealed that tamponade occurred within 24 hours of central line placement in only 36% of their cases. Tamponade occurred in 82% of their cases within 7 days, and one case occurred nearly 5 months after central line placement.
Second, van Haeften et al recommended that the use of a J-tipped guidewire and the roentgenographic confirmation of catheter location with or without the use of