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Safe techniques for inserting the hickman catheter in pediatric patients
Kouji Masumoto1, Tohru Uesugi, Kouji Nagata
1Department of Pediatric Surgery, Reproductive and Developmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. kmasu@pedsurg.med.kyushu-u.ac.jp
Insights
A modified technique using vascular dilators and a left-side approach improves Hickman catheter placement in children. This method reduces procedure time, complications like sheath kinking, and serum C-reactive protein (CRP) levels compared to the standard approach.
Area of Science:
- Pediatric Surgery
- Vascular Access
- Medical Device Technology
Background:
- Hickman catheter insertion via percutaneous central venous access is common in pediatric patients.
- Standard insertion methods can lead to complications such as sheath introducer kinking and damage.
- Modified techniques are being explored to enhance safety and efficiency.
Purpose of the Study:
- To compare the efficacy and safety of a modified percutaneous Hickman catheter insertion technique using vascular dilators against the standard method in children.
- To evaluate the impact of the modified technique on procedure duration, complication rates, and serum C-reactive protein (CRP) levels.
- To determine the optimal side (right vs. left) for catheter insertion.
Main Methods:
- A retrospective study of 41 pediatric patients undergoing Hickman catheter insertion.
- Comparison between a standard insertion kit method (16 patients) and a modified method using vascular dilators (25 patients).
- Analysis of procedure time, complication rates (sheath kinking/damage), and peak serum CRP levels, comparing both methods and right vs. left approaches.
Main Results:
- The modified technique significantly reduced procedure time compared to the standard method.
- The modified technique showed a lower incidence of sheath introducer kinking and damage.
- The modified group exhibited significantly lower peak serum CRP levels.
- The left-side approach was associated with shorter procedure times and lower CRP levels in both methods.
- Technical complications were more frequent with the right-side approach in the standard group.
Conclusions:
- The modified percutaneous technique utilizing vascular dilators offers a safer and smoother Hickman catheter insertion in pediatric patients.
- The left-side approach appears advantageous for reducing procedure time and inflammatory response (serum CRP).
- This modified method is recommended for improving outcomes in pediatric central venous access procedures.
Abstract:
The placement of the Hickman catheter in the central veins is thought to be an effective method for providing venous access in various clinical situations in children. The catheter is usually inserted by the percutaneous approach, but in some cases various troublesome complications can occur, such as sheath introducer kinking or damage, in addition to other major ones. Therefore, some modified techniques, using vascular dilators, both to dilate the route and to avoid such complications, have been developed and investigated to obtain a smooth and safe percutaneous insertion of the Hickman catheter in children. A total of 41 Hickman catheters were inserted by the percutaneous method in 41 pediatric patients from 1996 to 2004 in our department. Sixteen catheters were inserted by means of a standard method, using the manufacturer's insertion kit, and 25 catheters were inserted by means of a modified method, namely, using various sized vascular dilators. The length of time for the procedure, the complication rate, and the changes in the serum C-reactive reaction (CRP) levels were then compared between the standard and the modified methods. Those parameters were also compared between a right-side and left-side approach using both methods, to clarify which side was better for the insertion of this catheter. The length of time for the catheter replacement procedure in the standard group was significantly longer than that in modified one. The occurrence rate for both the kinking and small damage to the sheath introducer in the standard group was higher than that in the modified one. The peak of serum CRP in the modified group was significantly lower than that in the standard one. When comparing a right-side and left-side approach, 7 catheters out of 16 were inserted by the right-side approach in the standard group, while 10 catheters out of 25 were done by the right-side approach in the modified group. The length of time for the procedure for the left-side approach was significantly shorter than that for the right-side one in both groups. No difference in technical complications was observed between the two different approaches in the modified group, while complications when using the right-side approach often occurred in the standard group. The peak of serum CRP in the left-side approach was lower than that in the right-side one in both groups. The use of the modified percutaneous method, using various sized vascular dilators and the left-side approach, was therefore found to be useful for the safe and smooth placement of the Hickman catheter in children.
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