**15. Central venous access**

The use of long-term venous access is now an integral component of treatment for patients receiving long-term antibiotic administration or hyperalimentation or undergoing chemotherapy. Externalized tunneled catheters were introduced almost 30 years ago, but required daily cleaning and frequent flushing190,191. On average, deep venous thrombosis (DVT) can complicate approximately 2%–6.7% of such port placements192 – 194, although literature reports have ranged from 0% to 26%195–198. In 1991, Monreal et al.199 observed that 4 of 30 consecutive patients with upper extremity deep venous thrombosis (DVT) had PE (13.3%), but more importantly, all these 4 occurred in 20 catheter related DVT patients (20%), while none of 10 patients with primary upper extremity DVT had PE.
