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Placement of Hickman-Broviac catheters in the cephalic vein
1Department of Surgery, Columbia-Presbyterian Medical Center, New York, New York 10032.
Insights
This study demonstrates that a high deltopectoral triangle incision reliably allows successful central venous catheter cannulation, even when the cephalic vein is absent or small. Alternative veins or contralateral approaches ensure high success rates for central line placement.
Area of Science:
- Vascular Surgery
- Anatomy
- Medical Device Placement
Background:
- Central venous catheterization is a critical medical procedure.
- Identifying and accessing suitable veins for cannulation can be challenging.
- The deltopectoral triangle is a common anatomical landmark for venous access.
Purpose of the Study:
- To evaluate the efficacy of a specific surgical approach for central venous catheterization.
- To determine the success rate of cannulating veins in the deltopectoral triangle.
- To identify alternative strategies when primary venous targets are unsuitable.
Main Methods:
- A surgical incision was placed high in the deltopectoral triangle.
- Attempts were made to cannulate the cephalic vein.
- Alternative veins in the region were accessed if the cephalic vein was inadequate.
- Contralateral dissection was performed if ipsilateral access failed.
- Catheter placement was monitored, with adjustments made for malpositions (e.g., external jugular vein).
Main Results:
- The described incision technique consistently allowed cannulation of alternative veins when the cephalic vein was absent or too small.
- Contralateral dissection proved successful in rare cases of bilateral venous unavailability.
- Malposition into the external jugular vein was observed occasionally but was correctable.
- Repeat attempts at central placement after initial challenges were usually successful.
Conclusions:
- A high deltopectoral triangle incision is a reliable method for central venous catheterization.
- This approach maximizes the chances of successful venous access, minimizing the need for more invasive procedures.
- The technique offers a robust solution for challenging venous anatomy during central line insertion.
Abstract:
By approaching the cephalic vein with an incision placed high in the deltopectoral triangle, instances in which the cephalic vein is absent or too small to cannulate will almost always result in the successful cannulation of an alternative vein located in this region. In those rare instances in which there is no vein which can be cannulated on one side, contralateral dissection is likely to be successful. Occasionally, a catheter will be seen to pass over the clavicle into the external jugular vein. The catheter should be withdrawn and rethreaded because repeat attempts at central placement will usually be successful.