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Insertion of Hickman catheters. A comparison of cutdown and percutaneous techniques
Insights
Percutaneous Hickman catheter insertion offers a faster procedure with similar complication rates compared to the cutdown technique. This method is recommended for long-term vascular access, except in patients with coagulopathy.
Area of Science:
- Vascular Surgery
- Medical Devices
- Patient Care
Background:
- Long-term vascular access is crucial for managing various medical conditions.
- Hickman catheters are a common solution for prolonged venous access.
- Percutaneous insertion is gaining popularity due to its perceived speed and simplicity.
Purpose of the Study:
- To compare the efficacy and safety of percutaneous versus cutdown techniques for Hickman catheter insertion.
- To evaluate operating time and complication rates for both insertion methods.
Main Methods:
- Retrospective review of 82 Hickman catheter insertions in adult patients.
- Data collected on success rates, operating time, and complications for cutdown and percutaneous techniques.
Main Results:
- Percutaneous technique achieved a 96% success rate (48/50 patients) versus 94% for cutdown (30/32 patients).
- Average operating time was significantly shorter for percutaneous insertion (33 min) compared to cutdown (77 min).
- Overall complication rates were comparable: 16% for percutaneous and 18% for cutdown.
Conclusions:
- Percutaneous Hickman catheter insertion is a faster procedure with minimal morbidity compared to the cutdown method.
- The cutdown technique remains a viable option for patients with coagulopathy or anticipated difficulties with percutaneous insertion.
- Both methods carry risks, including potential complications associated with subclavian puncture.
Abstract:
The insertion of Hickman catheters is useful in providing long-term vascular access in patients with a variety of conditions. Recently, enthusiasm has developed for the percutaneous insertion of the catheter because of the speed and ease of insertion. The insertion of 82 Hickman catheters in adults was reviewed. Thirty (94%) of 32 patients had a catheter placed successfully using a cutdown technique with success in 75 per cent of patients with the initial cutdown. Catheter placement was successful in 48 (96%) of the 50 patients with the percutaneous technique. The average operating time was 77 min for the cutdown technique compared with 33 min with percutaneous insertion. The overall complication rate was 18 per cent using the cutdown technique and 16 per cent for the percutaneous technique. The percutaneous technique for inserting Hickman catheters results in a much shorter operating time with minimal morbidity. As with any subclavian puncture, however, there is the risk of significant complications. The cutdown technique should be considered in patients with coagulopathy and when difficulty performing a percutaneous insertion is anticipated.