Radiologic placement of Hickman catheters

Hickman catheter insertion is usually accomplished surgically by means of either cutdown on the cephalic or jugular veins or percutaneous placement in the operating room. Sixty Hickman catheters were placed percutaneously in an interventional radiology suite in 51 consecutive patients. Complications included one case of pneumothorax and pulmonary artery air embolism (1.7%); one case of brachiocephalic vein thrombosis (1.7%); one case of arterial puncture in a patient with a coagulopathy causing mediastinal hemorrhage, sepsis, and eventual death (1.7%); four cases of catheter sepsis (6.7%); and three cases of suspected local infection or inflammation (5.0%). These rates are comparable to those in surgical series. Radiologic methods increased the convenience, decreased the time and cost of insertion, and enabled superior fluoroscopic control. Modern angiographic materials provide improved safety during access to the subclavian vein. The authors conclude that radiologic Hickman catheter placement offers significant advantages over traditional surgical placement.