Fatal Cardiac Tamponade

To the Editor.—  Drs Sheep and Guiney recently reported a case of fatal cardiac tamponade after left internal jugular vein catheterization. Since we have recently published our experience with a similar complication using a dialysis catheter,¹I would like to make two comments concerning this article.Drs Sheep and Guiney discuss the possibility of perforation during insertion caused by vessel-tip erosion of a vein wall. Although they state that perforation may occur during the threading of a rigid catheter using the Seldinger technique, they conclude that this is unlikely because of the flexibility of the guidewire at both ends. I would like to call attention to the fact that not all guidewires are flexible at both ends, and, indeed, the guidewires that we use for dailysis (Cobe Laboratory guidewire for femoral dialysis catheters) are flexible at only one end. Furthermore, I would like to repeat our admonition that perforation