Insertion of Hickman central venous catheters by using angiographic techniques in patients with hematologic disorders.

Department of Diagnostic Radiology, Royal Postgraduate Medical School, Hammersmith Hospital, London, Great Britain.
American Journal of Roentgenology (Impact Factor: 2.9). 08/1992; 159(1):121-4.
Source: PubMed

ABSTRACT During a 9-month period, 69 Hickman catheters were successfully inserted by using angiographic techniques in 59 patients with hematologic disorders. A pneumothorax, which did not require drainage, developed in one patient. No other significant complications occurred at the time of insertion. Eighteen catheters were removed electively, 15 are still in situ, six were removed for thrombosis, and five were accidentally removed. Infection precipitated removal in six subjects. Ten patients died with the catheter in place. Five catheters were removed in patients with refractory septicemia of unknown origin. One catheter burst during an injection and had to be removed. Three patients were lost to follow-up. There were 3.24 infectious episodes per 1000 days of catheterization, more than twice the rate found in some other series. The results of this study are compatible with the growing body of evidence in favor of the angiographic insertion of Hickman catheters. The apparently high rate of infection is ascribed to factors other than insertion in the angiography suite, including the high proportion of bone marrow transplantation patients.

  • [Show abstract] [Hide abstract]
    ABSTRACT: The placement of the Hickman catheter in the central veins is thought to be an effective method for providing venous access in various clinical situations in children. The catheter is usually inserted by the percutaneous approach, but in some cases various troublesome complications can occur, such as sheath introducer kinking or damage, in addition to other major ones. Therefore, some modified techniques, using vascular dilators, both to dilate the route and to avoid such complications, have been developed and investigated to obtain a smooth and safe percutaneous insertion of the Hickman catheter in children. A total of 41 Hickman catheters were inserted by the percutaneous method in 41 pediatric patients from 1996 to 2004 in our department. Sixteen catheters were inserted by means of a standard method, using the manufacturer's insertion kit, and 25 catheters were inserted by means of a modified method, namely, using various sized vascular dilators. The length of time for the procedure, the complication rate, and the changes in the serum C-reactive reaction (CRP) levels were then compared between the standard and the modified methods. Those parameters were also compared between a right-side and left-side approach using both methods, to clarify which side was better for the insertion of this catheter. The length of time for the catheter replacement procedure in the standard group was significantly longer than that in modified one. The occurrence rate for both the kinking and small damage to the sheath introducer in the standard group was higher than that in the modified one. The peak of serum CRP in the modified group was significantly lower than that in the standard one. When comparing a right-side and left-side approach, 7 catheters out of 16 were inserted by the right-side approach in the standard group, while 10 catheters out of 25 were done by the right-side approach in the modified group. The length of time for the procedure for the left-side approach was significantly shorter than that for the right-side one in both groups. No difference in technical complications was observed between the two different approaches in the modified group, while complications when using the right-side approach often occurred in the standard group. The peak of serum CRP in the left-side approach was lower than that in the right-side one in both groups. The use of the modified percutaneous method, using various sized vascular dilators and the left-side approach, was therefore found to be useful for the safe and smooth placement of the Hickman catheter in children.
    Pediatric Hematology and Oncology 01/2006; 23(7):531-40. · 0.90 Impact Factor
  • CardioVascular and Interventional Radiology 11/1994; 17(6). · 2.14 Impact Factor
  • Journal of Vascular and Interventional Radiology 01/1996; 7(3):439-40. · 2.00 Impact Factor


Available from