Insertion of long term central venous catheters: time for a new look

BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7001.341 (Published 05 August 1995) Cite this as: BMJ 1995;311:341
  1. Andy Adam, Professor of interventional radiology
  1. Department of Radiology, United Medical and Dental Schools of Guy's and St Thomas's Hospitals, London SEI 9RT

    Imaging guidance and skills in manipulating catheters ensure successful placement and convenience for the patient

    Central venous catheters and ports are used to administer chemotherapy, antibiotics, parenteral nutrition, blood products, and cardiovascular pressor agents. Catheters are being used more commonly as more patients are being treated for leukaemia, solid tumours, infection, and AIDS.1 The prototype central venous catheter inserted via a subcutaneous tunnel for long term use is the Hickman catheter.2 At present such catheters may be inserted in three ways: by a surgical venous cutdown or by percutaneous puncture with or without imaging guidance.

    Traditionally central venous catheters for long term use have been inserted by surgeons using a cutdown technique in the operating theatre under general anaesthesia. The catheter was inserted into the subclavian vein and advanced along the superior vena cava to the right atrium. The drawbacks of this method include a relatively low success rate (75%), a long operating time, and the fact that the vein is compromised for future use.3

    In many hospitals these disadvantages have led to the cutdown technique being replaced by percutaneous methods.3 4 5 The procedure is still often commonly carried out in the operating theatre under general anaesthesia—probably because surgeons and anaesthetists are accustomed to that setting. Local anaesthesia is being used increasingly often, but in most cases imaging guidance is not used for …

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