"Blind" placement of long-term central venous access devices: Report of 589 consecutive procedures

Placement of long-term central venous access devices, such as Hickman cathe ters and implanted subcutaneous ports, has traditionally been performed in the operating room with fluoroscopy. This study reports our experience with percutaneous placement of these devices in the outpatient clinic setting w ithout the use of real-time imaging. Results were generated from a prospect ive database of all adult patients undergoing placement of central venous a ccess in the outpatient clinic of the Wake Forest University Baptist Medica l Center. This database revealed that during the years 1996 and 1997, long- term central venous catheter placement was attempted in 589 adult patients in the outpatient clinic. Technical success was achieved in 558 patients (9 2%). This included 278 tunneled catheters and 280 totally implanted devices . Repositioning of the catheter tip was required in 16 patients (2.9%). The incidence of pneumothorax was 1.9 per cent. Late complications, including infection and thrombosis, occurred in 9 per cent. The average procedure-rel ated charge for placement of a single-lumen central venous port in the outp atient clinic was $1691 versus $4559 in the operating room and $3890 in the radiology department. We conclude that routine placement of long-term cent ral venous access devices in the outpatient clinic, without the use of real -time imaging, yields acceptable success rates and may have economic advant ages over procedures performed in the operating room or radiology departmen t.