Abstract
<h3>In Reply.—</h3> Dr Mitchell describes what we have found to be a common occurrence among physicians who have compared the SC and IC routes with subclavian vein catheterization. In our experience, there has been a preference for the SC approach, especially among the residents in emergency medicine, because it is both easier to perform and also associated with fewer complications. During CPR, the choice becomes even more clear. When simple alternatives to the IC subclavian venipuncture exist, it is difficult to justify either puncture of the mobile chest wall or the interruption of CPR. In this setting, we have found that internal jugular cannulation (middle approach) is technically more difficult than the SC subclavian route mainly because of interference with airway management. Furthermore, in those situations where the patient is volume depleted, the lack of ligamentous support that maintains the patency of the vein is not present with the jugular
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