Schummer W, et al. Mechanical complications and malpositions of central venous cannulations by experienced operators

21

The source of the two-attempt rule in section 21.11: after two failed passes at one site, the operator changes something (site, operator, or technique) rather than repeating. Not an ECPR study, which is precisely why the relationship generalises.

Number of attempts by the same operator

DOI 10.1007/s00134-007-0560-z

None (observational)

Central venous, not femoral arterial, and not during cardiac arrest; pre-dates routine ultrasound; the threshold of two is a practical reading of a continuous relationship.

Mechanical complication rate rises steeply with the number of attempts by the same operator.

1,794 central venous cannulation procedures by experienced operators