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Duplex scans before subclavian vein catheterization predict unsuccessful catheter placement
W D Haire1, T G Lynch, R P Lieberman
1Department of Internal Medicine, University of Nebraska Medical Center, Omaha 68198-3330.
Archives of Surgery (Chicago, Ill. : 1960)
|February 1, 1992
Summary
Subclavian vein thrombosis, a complication of cancer catheterization, can prevent future line placement. Preoperative duplex scanning effectively identifies patients with vein obstruction, improving procedural success rates.
Area of Science:
- Vascular Surgery
- Oncology
- Diagnostic Imaging
Background:
- Subclavian catheterization is common in cancer patients.
- Subclavian vein thrombosis (SVT) occurs in up to 38% of these patients.
- Recanalization of SVT is rare, potentially impeding future catheterizations.
Purpose of the Study:
- To determine the frequency of persistent subclavian vein occlusion after prior catheterization.
- To evaluate the utility of preoperative duplex scanning in identifying such obstructions.
- To assess the impact of these findings on subsequent catheter placement success.
Main Methods:
- Preoperative duplex scanning was performed on 22 patients with a history of subclavian catheters for chemotherapy.
- Subclavian vein catheterization was attempted subsequently, independent of duplex scan results.
- Intraoperative venography was used to confirm findings when catheterization failed.
Main Results:
- Nineteen scans were normal, with 18 successful catheter placements.
- Three scans revealed vein noncompressibility, and catheterization failed in all three.
- Persistent subclavian vein obstruction prevented successful catheter placement in 14% of patients.
Conclusions:
- Persistent subclavian vein obstruction after previous catheterization occurs in 14% of patients.
- Preoperative duplex scanning is a reliable method for identifying these obstructions.
- Duplex scanning can guide decisions and potentially improve success rates for subsequent subclavian catheter placement.