Totally implantable indwelling catheter system--alternative techniques of insertion

Totally implantable indwelling venous catheter systems represent a major advantage for patients requiring frequent or prolonged venous accesses. These catheters are usually inserted via the cephalic vein. When this approach is not feasible, alternative venous sites include the subscapular vein, the external jugular vein, the subclavian vein by direct puncture, the internal jugular vein by direct puncture and the saphenous vein. These techniques are herein reported to help the surgeon faced in the operating room with a difficult venous catheter placement.