HICKMAN CATHETERS - LEFT-SIDED INSERTION, MALE GENDER, AND OBESITY ARE ASSOCIATED WITH AN INCREASED RISK OF COMPLICATIONS

Background: Semipermanent tunnelled silicone rubber Hickman catheters are widely used to provide durable central venous access for patients with cancer or haematological disease. Aims: To document the frequency and severity of Hickman catheter related adverse events and to identi fy predisposing factors. Methods: A retrospective review was undertake n of 153 sequential Hickman catheters inserted into patients receiving treatment for cancer or haematological disease. All Hickman catheters were inserted percutaneously in a radiology department under local an aesthesia and fluoroscopic control. The exact position of the catheter tip was determined by reviewing post-insertion radiographs. Results: The median duration of catheter use was 55 days (range one-650). Compl ications led to the removal of 32% of catheters. Exit site infection c omplicated 22% of catheters, septicaemia 7%, migration or dislodgment 7%, and venous thrombosis 8%. Complications were more common in male p atients (exit site infection and catheter loss), in patients with acut e leukaemia (septicaemia) and in obese patients (catheter migration). Left sided catheters caused more venous thrombosis and were more likel y to malfunction or block. Left sided catheters required removal more frequently than right sided catheters. Termination of the Hickman cath eter within the high superior vena cava (SVC) resulted in loss of func tion earlier when compared to termination with the low SVC or right at rium (RA). Conclusions: Right-sided Hickman catheters terminating in t he low SVC/RA offer the best chance of durable function. The use of su bcutaneously tunnelled catheters in obese patients poses unique proble ms with catheter migration. Vigilance in the placement and care of Hic kman catheters remains essential.