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EDITOR—The death of a 15 year old girl in 1998 due to a complication of inserting a Hickman line, and the ensuing court case in December last year, highlight the considerable morbidity and occasional mortality associated with central venous access. In one year alone the Scottish audit of surgical mortality identified four deaths directly attributable to insertion of a venous line. A greater number of patients have …

We formulated a hypothesis to explain our patient's progressively worsening metabolic acidosis despite treatment for shock and hyperglycaemia. We proposed that the oxygen carrying capacity of her blood was impaired by the lipid, leading to tissue hypoxia and lactic acidosis. Plasma lactic acid concentrations could not be measured. We hoped our patient would be improved by removal of some of the excess lipid. We first tried lipid separation by plasmapheresis. This method failed as the grossly lipaemic blood clogged the plasma filter. We next tried a cell separator but this machine failed to distinguish blood cells from the lipaemic sludge and the tubing became clogged and blocked. Eventually separation by centrifuge was successful. A unit of blood (450 ml) was removed from the patient through a femoral venous line and centrifuged, separating the red cells from …