Related Experiment Videos
Percutaneous placement of Hickman catheters: comparison of sonographically guided and blind techniques
J S Laméris1, P J Post, H M Zonderland
1Department of Radiology, University Hospital Dijkzigt, Erasmus University, Rotterdam, The Netherlands.
Insights
Sonographically guided subclavian vein puncture improves success rates and significantly reduces complications for long-term central venous access device placement, such as Hickman catheters.
Area of Science:
- Medical Imaging
- Interventional Radiology
- Vascular Access
Background:
- Central venous catheters are crucial for long-term venous access, particularly for chemotherapy.
- Traditional blind subclavian vein puncture carries risks like pneumothorax and arterial puncture.
- Minimizing procedural complications is essential for patient safety and effective treatment.
Purpose of the Study:
- To evaluate the efficacy and safety of sonographically guided subclavian vein puncture for central venous catheter placement.
- To compare complication rates between sonographically guided and blind puncture techniques.
- To determine if ultrasound guidance enhances success and reduces risks in Hickman catheter insertion.
Main Methods:
- A comparative study involving 80 patients undergoing subclavian vein catheterization for long-term venous access.
- Group 1: 40 sonographically guided punctures; Group 2: 40 blind percutaneous punctures.
- Both groups underwent fluoroscopically controlled catheter placement; complication rates were meticulously recorded.
Main Results:
- Sonographically guided puncture achieved a 100% success rate, compared to 95% with blind puncture.
- Puncture-related complications were significantly lower in the sonographically guided group (0%) versus the blind group (10%).
- Specific complications like pneumothorax and hemothorax were exclusively observed in the blind puncture group.
Conclusions:
- Sonographically guided subclavian vein puncture is a superior technique for placing indwelling central venous catheters.
- Ultrasound guidance enhances procedural success and substantially decreases the incidence of puncture-related complications.
- This method offers a safer alternative for establishing long-term venous access, especially for patients with hematologic malignancies requiring chemotherapy.
Abstract:
We studied the value of sonographically guided puncture of the subclavian vein for placement of indwelling right atrial and permanent subcutaneously tunneled catheters (Hickman) for long-term venous access. The commonly used blind puncture is associated with complications such as pneumothorax, arterial puncture, and hemothorax. The results and complications of 40 sonographically guided punctures and fluoroscopically controlled catheterizations of the subclavian vein (group 1, 31 patients) performed in the radiology department were compared with those of 40 blind percutaneous punctures and fluoroscopically controlled catheterizations (group 2, 29 patients) performed in the operating room. The patients were selected consecutively. The groups were comparable in age, sex, and indication for catheter placement; administration of chemotherapy for hematologic malignancies was the major indication (group 1, 84%; group 2, 83%). All punctures in group 1 were successful; group 2 had two failures (5%). Puncture-related complications occurred significantly more in group 2 (10%) than in group 1 (0%) (p less than .05). These complications were pneumothorax in three cases and hemothorax in one. Complications not related to the puncture technique were prolonged bleeding at the entrance site (groups 1 and 2, two cases each), local infection (group 1, one case), thrombosis (group 1, three cases; group 2, two), catheter sepsis (group 1, 10 cases; group 2, 14), catheter occlusion (group 2, three cases), and catheter migration (groups 1 and 2, two cases each). We conclude that sonographically guided puncture increases the success rate and significantly decreases the puncture-related complications of percutaneous placement of Hickman catheters.