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Published on: December 23, 2014
Real-time ultrasound-guided supraclavicular technique as a possible alternative approach for Hickman catheter
Tomohiro Yamamoto1, Yuhki Arai2, Ehrenfried Schindler3
1Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Insights
A novel supraclavicular approach using real-time ultrasound guidance offers a viable alternative for tunneled Hickman/Broviac central venous catheter implantation when traditional routes fail. This technique provides a safe solution for patients with difficult central venous access.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Pediatric Surgery
Background:
- Tunneled Hickman/Broviac central venous catheters are essential for long-term therapies, typically accessed via subclavian or internal jugular veins.
- Repeated central venous access attempts can lead to thrombosis or stenosis, complicating future procedures.
- Identifying alternative central venous access routes is crucial to prevent serious complications.
Observation:
- A 1-year-old patient required Hickman catheter implantation after failed bilateral subclavian central venous catheterization attempts.
- Ultrasound revealed no available subclavian veins, necessitating an alternative approach.
- A real-time ultrasound-guided right supraclavicular approach was successfully employed.
Findings:
- The study introduces a real-time ultrasound-guided supraclavicular approach as an alternative for central venous catheter implantation.
- Step-by-step instructions, figures, and video demonstrate the procedure.
- The article discusses the advantages and disadvantages of supraclavicular versus other approaches.
Implications:
- This supraclavicular technique provides a critical alternative for patients with challenging central venous access.
- It expands the options for safe and effective tunneled central venous catheter placement.
- The findings contribute to improved patient outcomes in long-term venous access management.
Background:
Tunneled Hickman/Broviac central venous catheter implantation is performed when patients require a central vein route for long-term therapy. The subclavian or internal jugular vein approach is often chosen for their implantation sites. However, access to the central vein can be difficult owing to thrombosis or stenosis when the same vein has already been accessed several times. In such situations, other possible alternative approaches to the central vein should be considered to avoid serious complications owing to further unsuccessful attempts.
Description Of Operative Technique:
We encountered a 1-year-old patient admitted to our hospital for a Hickman catheter implantation after multiple unsuccessful attempts at central venous catheter insertion via bilateral subclavian approaches in another hospital. An ultrasound showed that no more subclavian veins were available on either side. A real-time ultrasound-guided right supraclavicular approach was performed as a solution to this situation.
Conclusions:
In this article, we introduce a real-time ultrasound-guided supraclavicular approach as a possible alternative method for Hickman catheter implantation. We present step-by-step instructions including figures and a video and further discuss the advantages and disadvantages of this procedure, comparing the right and left approaches with references to existing literature.
Level Of Evidence:
Level I.
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