INSERTION OF GROSHONG CENTRAL VENOUS CATHETERS UTILIZING FLUOROSCOPICTECHNIQUES

Groshong central line indwelling catheters are extensively used in gyn ecologic oncology patients for administration of chemotherapy, intrave nous fluids, and pain medications. They are easy to maintain and have a good safety record. We report on the placement of these central veno us catheters under direct fluoroscopic visualization as a method which is safe, inexpensive, and efficacious in high-risk patients. Fluorosc opic visualization during insertion provides several advantages: visua lization of bony landmarks-, placement of the guidewire into the subcl avian vein and superior vena cava under direct visualization, and conf irmation of appropriate distal placement of the Groshong catheter. Pat ient advantages include the following: (1) avoidance of unnecessary pu nctures to access the subclavian vein; (2) verification of guidewire p lacement to avoid cephalic placement; (3) passage of the guidewire onl y as far as the right atrium to avoid potential dysrrhythmias secondar y to right ventricular irritation, and (4) a savings of approximately 60% over insertion in the general operating room. Thirty patients had placement under fluoroscopic visualization in the angiography suite of Georgetown University Hospital. The average age of the patients was 5 8 years (42-78). Sixteen patients had ovarian cancer, 6 had endometria l cancer, 5 had cervical cancer, and 3 had other gynecologic malignanc ies. Fifteen patients had catheters placed for chemotherapy, 14 for hy dration, and 1 for pain control. Ten patients had had previous central venous catheters: 6 had been removed for infection, 2 for thrombus, 1 for completion of chemotherapy, and 1 for catheter kinkage. All 10 wi th previous catheters had successful placement of catheters in the ang iography suite. Complications from insertion were minimal with one asy mptomatic pneumothorax and one proximal port in an extravascular posit ion. We present the technique of fluoroscopic insertion of Groshong ca theters which is an effective method of placement in high-risk patient s. (C) Academic Press Inc.