ROUTINE FLUOROSCOPIC GUIDANCE IS NOT REQUIRED FOR PLACEMENT OF HICKMAN CATHETERS VIA THE SUPRACLAVICULAR ROUTE

The purpose of this study was to evaluate the efficacy and safety in p lacement of Hickman catheters via the supraclavicular route without fl uoroscopic guidance. We studied 81 consecutive percutaneous placements of dual lumen Hickman catheters via the supraclavicular route without the use of fluoroscopic guidance. Success rates, technical problems, complications, infections and reasons for explantation were recorded p rospectively, Seventy-nine punctures were successful (97.5%). One pneu mothorax (1.2%) and three accidental arterial punctures (3.7%) occurre d. Difficulties in introducing the catheter through the peel away shea th or misplacement were not observed. The catheters remained in place for a total of 7657 days (mean 94.5, range 3-392 days). Sixteen blood cultures were positive (2.1/1000 catheter days). Five catheters (6.1%) were lost because of mechanical complications. Forty-two lines (52%) were removed electively, 23 (28.4%) because of suspected infection, an d two (2.5%) because of tunnel infection. Nine patients died with a fu nctioning catheter, We conclude that the supraclavicular approach to t he subclavian vein is safe and efficient for introduction of Hickman c atheters, Using this access, routine fluoroscopic or sonographic guida nce is not required for proper placement. Implantation of the lines in an intensive care unit did not lead to higher infection rates than th ose reported in the literature.