PERCUTANEOUS NONANGIOGRAPHIC INSERTION OF HICKMAN CATHETERS IN MARROWTRANSPLANT RECIPIENTS BY ANESTHESIOLOGISTS AND INTENSIVISTS

Long-term central venous lines for chronic hemoaccess are usually inse rted in the operating theater under local or general anesthesia or in interventional radiology suites using fluoroscopic technique. In a pro spective study we determined the feasibility of percutaneous insertion of Hickman catheters without fluoroscopic control by anesthesiologist s and intensivists in the setting of an intensive care unit. Fifty-fou r Hickman catheters were placed in 53 consecutive patients with hemato logical disorders and/or neoplastic diseases undergoing allogeneic or autologous bone marrow transplantation (BMT) or buffy coat therapy. Th ere were no major complications. The mean time for insertion was 35 mi n. The median life span of catheters was 70 days (range 3-214). Twenty -six catheters were electively removed; six remained functioning in si tu at the end of the study. For 3333 catheter days (1471 days in hospi tal and 1862 days at domiciliary care), six catheters were removed bec ause of mechanical complications (inadvertent dislodgement, leak, seco ndary migration) and 14 because of suspected or documented infection. We conclude that percutaneous nonangiographic insertion of Hickman cat heters by anesthesiologists minimizes technical expenditure and is at least as effective as surgical or radiological techniques. The rate of clinically important complications is acceptable.