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Related Experiment Videos

Complications associated with different insertion techniques for Hickman catheters

Z Ahmed1, Z Mohyuddin

  • 1Department of Thoracic and Vascular Surgery, Mafraq Hospital, Abu-Dhabi, United Arab Emirates.

Postgraduate Medical Journal
|June 9, 1998
PubMed
Summary

Percutaneous insertion of Hickman catheters without tunnelling is safer for cancer patients with hematological malignancies. This technique significantly reduces bleeding, haematoma, and infection risks compared to the cut-down method.

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Area of Science:

  • Oncology
  • Vascular Surgery
  • Infectious Diseases

Background:

  • Central venous access is crucial for cancer patient care, with indwelling central venous catheters (CVCs) facilitating treatment delivery.
  • Pancytopenia in hematological malignancies can increase morbidity associated with CVCs.
  • Hickman catheters are commonly used CVCs in these patients.

Purpose of the Study:

  • To evaluate the impact of two different Hickman catheter placement techniques on patient morbidity.
  • To compare the incidence of immediate and delayed complications between percutaneous and cut-down insertion methods.

Main Methods:

  • A comparative study involving 177 patients with hematological malignancies undergoing Hickman catheter insertion.
  • Group 1 (n=112): Percutaneous subclavian vein insertion without prior tunnelling.

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  • Group 2 (n=65): Tunnelled cephalic/external jugular vein insertion via a cut-down technique.

    • Main Results:

    • The cut-down group experienced significantly higher rates of bleeding (61% vs. 8%) and haematoma (41% vs. 0%) compared to the percutaneous group.
    • Infective complications were more frequent in the cut-down group: exit site infection (26% vs. 7%), tunnel infection (18% vs. not specified), and septicaemia (41% vs. 19%).
    • Percutaneous insertion without tunnelling demonstrated a lower incidence of both mechanical and infectious complications.

    Conclusions:

    • The catheter placement technique significantly influences immediate and delayed complications in patients with hematological malignancies.
    • Percutaneous insertion without tunnelling is associated with lower morbidity, including reduced bleeding, haematoma, and infection rates.
    • Percutaneous insertion without tunnelling is recommended as the preferred technique for Hickman catheter placement in this patient population.