Efficacy of same venous route Hickman catheter replacement in patients with intestinal failure

Abstract

Periodical replacement of venous Hickman catheters is required for the nutritional care of patients with intestinal failure. The conventional de novo operation (DN-OP) involves inserting the catheter into a new venous tract in each replacement; however, this could result in fast consumption of functional central vessels in patients with intestinal failure. Recently, same-route operation (SR-OP) has been adopted as an alternative approach for retaining venous access. We conducted a retrospective study to compare the efficacy of Hickman catheters and the survival of venous vessels using two different operative strategies. Overall, 181 catheters were inserted, 109 using DN-OP and 72 using SR-OP. The mean catheter duration was 11.9±8.8 months in the DN-OP group and 10.5±5.6 months in the SR-OP group; the infection rate was 0.74 in the DN-OP group and 0.44 in the SR-OP group. The vein accesses used in these insertions (n=113) were classified: the DN-vein group for veins accessed only by DN-OP (n=75) and the SR-vein group for veins accessed by an initial DN-OP and subsequent SR-OPs (n=38). Mean working duration per vein access was 12.3±10.1 months in the DN-vein group and 28.2±14.8 months in the SR-vein group (p<0.001); mean infection-free duration was 11.4±10.1 months in the DN-vein group and 27.7±15.3 months in the SR-vein group (p<0.001). Application of SR-OP in Hickman catheter replacement significantly extended the working duration of venous access by re-using the same venous route without compromising catheter efficacy in patients with IF having poor venous access.