BMJ 1995;311:1090-1091 (21 October)

Letters

Difficulties are rare and do not correlate with lifespan of catheter

EDITOR,--We strongly support Andy Adam's view that imaging guidance and experience are necessary for the placement of Hickman-type catheters.1 The first surgical insertions of Hickman catheters at the Royal Marsden Hospitals were described in 1979,2 but over the past decade the anaesthetists have developed a comprehensive percutaneous venous access service, and they currently insert over 1000 lines a year. Dedicated theatre lists of up to 10 patients are eminently suitable for consultants to teach the technique to trainee anaesthetists.

Oncology patients are carefully worked up preoperatively: clotting function is optimised and the suitability of the site of insertion assessed. In complicated cases, in which there is chest disease or venous thrombosis, radiological investigations are performed with the full cooperation of the radiology department. The lines are inserted with a combination of good quality sedation for adults, general anaesthesia for children, safe doses of local anaesthetics, oxygen treatment, and full monitoring. . . . [Full text of this article]


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Relevant Article

Insertion of long term central venous catheters: time for a new look
Andy Adam
BMJ 1995 311: 341-342. [Extract] [Full Text]

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