USE OF THE HICKMAN-CRAWFORD CRITICAL CARE CATHETER IN MARROW TRANSPLANT RECIPIENTS - A PULMONARY-ARTERY CATHETER-ADAPTABLE CENTRAL VENOUS ACCESS

Objective: To describe the use of a modified 15.5-Fr double-lumen, tun neled right atrial catheter (Hickman-Crawford catheter) in adult bone marrow transplant recipients, that permits passage of a 5-Fr pulmonary artery catheter through the larger of the catheter's lumens. Design: A case series review of the clinical experience with a modification of the existing central venous catheter design. Setting: A bone marrow t ransplantation center. Patients: Fourteen patients (weighing at least 50 kg body weight) undergoing bone marrow transplantation. Ages ranged from 18 to 64 yrs (median 40). There were nine male and five female p atients. All patients, except for three who were receiving autologous marrow transplants, underwent allogeneic transplants. Measurements and Main Results: Sixteen catheters were inserted into the subclavian vei n in 14 patients. The catheters remained in place for a mean of 44 day s (median 30; range 6 to 107) and 56% remained functional until remove d an average of 60 days later at the time of death (n = 5) or discharg e to home (n = 4). One catheter was accidentally dislodged by the pati ent and six catheters (38%) were electively removed, two because of in fection and four because of mechanical occlusion or damage. The Hickma n-Crawford catheter was used as venous access for insertion of 21 pulm onary artery catheters in 12 patients (twice in seven patients). Ninet y percent of these insertions (19 of 21) were done without difficulty; use of a guidewire was required in the remaining two cases. No compli cations of pulmonary artery catheterization were seen. Conclusions: Th is experience illustrates that a tunneled right atrial catheter for lo ng-term use can be employed safely and repeatedly for insertion of pul monary artery catheters for central hemodynamic monitoring