A simplified technique of Hickman catheter insertion at bedside in gynecologic oncology patients

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In 23 patients with gynecologic malignancies, 24 Hickman catheters were placed for long-term venous access. Using the described percutaneous supraclavicular approach, the right brachiocephalic vein was successfully cannulated in 23 patients. One patient required removal of her catheter because of fungal sepsis and another catheter was later placed from the left supraclavicular approach. In two patients, catheter placement was unsuccessful, resulting in a success rate of 24:26 (92%). Twenty-one catheters were placed at the bedside and three others using the same technique were placed in the operating room concomitant with a major operative procedure. Infectious complications occurred in 3 patients (12%) and complications associated with catheter maintenance occurred in 4 (16%) patients. Total procedure time was 15-30 min. Based on our findings, we believe that the right supraclavicular placement of the Hickman catheter is an easily taught procedure which can be performed safely at the patient’s bedside, resulting in significant cost containment. Many “simplified” techniques of semipermanent silicone central venous or right atria1 catheter placement have been described since Heimbach and Ivey [I] outlined their standard method of insertion in 1976. An important contribution was the introduction of the percutaneous approach to catheter placement described by Stellato [2] and Linos [3]. Both authors, utilizing the Seldinger technique, describe the use of a vein dilator and peel-away Teflon sheath in their method. Recently, Rettenmaier [4,5] described the safe percutaneous placement of the right atrial catheter at the bedside without the need for fluoroscopy. With increasing stress placed on cost containment, a simple, safe and effective method of catheter placement is important. The generally accepted method of percutaneous catheter placement is by the