A COMPARATIVE-ANALYSIS OF RADIOLOGICAL AND SURGICAL PLACEMENT OF CENTRAL VENOUS CATHETERS

Purpose: To compare the differences in practice and outcome of all rad iologically and surgically placed central venous catheters retrospecti vely over a 2-year period simultaneously, at a single institution. Met hods: A total of 253 Hickman catheters were inserted in 209 patients; 120 were placed radiologically in 102 patients and 133 were placed sur gically in 107 patients. The indication was chemotherapy in 76% of rad iological and in 47% of surgical cases; the remainder were for total p arenteral nutrition and venous access. Results: There were 6 (4.5%) pr imary surgical failures and a further 17 (13%) surgical cases requirin g multiple placement attempts, Pneumothorax occurred once (0.8%) surgi cally and four times (3.3%) radiologically, There were no radiological primary misplacements but there were five (3.7%) surgical ones. Cathe ter or central vein thrombosis occurred in four (3.3%) radiological an d five (3.7%) surgical cases. The rate of infection per 1000 catheter- days was 1.9 in radiologically placed catheters and 4.0 in surgically placed ones (p < 0.001). Average catheter life-span was similar for th e two placement methods (100 +/- 23 days). Conclusion: Radiological pl acement is consistently more reliable than surgical placement, There a re fewer placement complications and fewer catheter infections overall .