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Hickman catheter placement simplified
Hickman Catheter Placement Simplified
Norman L. Wool, MD, Chicago, Illinois Albert K. Straus, MD, Chicago, Illinois David L. Roseman, MD, Chicago, Minois
The Hickman indwelling right atria1 catheter has proved to be an invaluable tool for vascular access in selected patients. Since its introduction in 1977, it has been used increasingly often to draw blood and to administer parenteral fluids, hyperalimentation solutions, blood products, and medications. It is enthusiastically endorsed by patients, who no longer need to endure the pain and anxiety of repeated and often difficult venipuncture for phlebotomy and intravenous catheterization. Indications and specific techniques for catheter placement have been published previously [l-3]. Strict aseptic technique in the operating room and radiologic confirmation of placement in the right
atrium are mandatory. We have found that the external jugular vein is the most reliable point of access if it can be visualized and if its anatomic configuration is normal. Catheters have been successfully placed in bilateral external jugular, cephalic, internal jugular, and saphenous veins. A most useful aid to catheter placement is to use a Hemovace (Snyder Laboratories, Inc., Warsaw, IN) trocar to create the subcutaneous tunnel, with minimal trauma and pain. Technique The selected site of venous cannulation is first exposed with a cutdown. The end of the sterilized Hickman catheter
Flgwe 1. Tunneling of catheter wHh a trocar.
From the Department of General Surgery, Rush-Presbyterian-St. Luke’s Medical Center, Chicago, Illinois. Requests fcf reprints should be addressed to Norman L. Wool, MD, Suite 868. 1725 W. Harrison Street, Chicago, Illinois 60612.
volume 145,
February1993
F/#ure 2. Catheter In place in proximal dghi at&m. Nofe posnlon of Dacron@ cuff.
283
Hickman Catheter Placement
is then screwed onto the threaded end of a medium Hemovac trocar, which has been manually straightened. The catheter is further secured with a 2-O silk tie just proximal to the threaded portion of the trocar. The trocar and the catheter are then inserted through a 1.5 cm stab wound approximately 10 cm from the cannulation site. The trocar is easily advanced through subcutaneous tissue and grasped with a large hemostat to advance it through the cutdown site (Figures 1 and 2).
Comments We have used this technique in more than 75 patients. Besides easing the placing of the catheter, there is considerably less discomfort to the patient than with the standard tunneling procedure. Often, only a local anesthetic is required at the stab wound site. We have also noted less postoperative ecchymosis in the subcutaneous tunnel, which is especially important in the many patients with thrombocytopenia.
284
Summary A simplified technique to place the Hickman indwelling right atria1 catheter has been devised. This involves securing the catheter to a trocar, which is easily advanced to the cutdown site of the selected vein. Experience in more than 75 patients shows this technique to be associated with less discomfort and fewer complications than seen with standard techniques.
References 1. Heimbach DM, lvey TD. Technique for placement of a permanen? home hyperalimentation catheter. Surg Gynecol Obstet 1976:143:634-6. 2. Hickman RO. Buckner CD, Clift RA, Sanders JE, Stewart P, Thomas ED. A modified right atrial catheter for access to the venous system in marrow transplant recipients. Surg Gynecol Obstet 1969;148:871-5. 3. Bjeletich J, Hickman RO. The Hickman indwelling catheter. Am J Nursing 1980;80:62-5.
The American Journal of Surgery
Norman L. Wool, MD, Chicago, Illinois Albert K. Straus, MD, Chicago, Illinois David L. Roseman, MD, Chicago, Minois
The Hickman indwelling right atria1 catheter has proved to be an invaluable tool for vascular access in selected patients. Since its introduction in 1977, it has been used increasingly often to draw blood and to administer parenteral fluids, hyperalimentation solutions, blood products, and medications. It is enthusiastically endorsed by patients, who no longer need to endure the pain and anxiety of repeated and often difficult venipuncture for phlebotomy and intravenous catheterization. Indications and specific techniques for catheter placement have been published previously [l-3]. Strict aseptic technique in the operating room and radiologic confirmation of placement in the right
atrium are mandatory. We have found that the external jugular vein is the most reliable point of access if it can be visualized and if its anatomic configuration is normal. Catheters have been successfully placed in bilateral external jugular, cephalic, internal jugular, and saphenous veins. A most useful aid to catheter placement is to use a Hemovace (Snyder Laboratories, Inc., Warsaw, IN) trocar to create the subcutaneous tunnel, with minimal trauma and pain. Technique The selected site of venous cannulation is first exposed with a cutdown. The end of the sterilized Hickman catheter
Flgwe 1. Tunneling of catheter wHh a trocar.
From the Department of General Surgery, Rush-Presbyterian-St. Luke’s Medical Center, Chicago, Illinois. Requests fcf reprints should be addressed to Norman L. Wool, MD, Suite 868. 1725 W. Harrison Street, Chicago, Illinois 60612.
volume 145,
February1993
F/#ure 2. Catheter In place in proximal dghi at&m. Nofe posnlon of Dacron@ cuff.
283
Hickman Catheter Placement
is then screwed onto the threaded end of a medium Hemovac trocar, which has been manually straightened. The catheter is further secured with a 2-O silk tie just proximal to the threaded portion of the trocar. The trocar and the catheter are then inserted through a 1.5 cm stab wound approximately 10 cm from the cannulation site. The trocar is easily advanced through subcutaneous tissue and grasped with a large hemostat to advance it through the cutdown site (Figures 1 and 2).
Comments We have used this technique in more than 75 patients. Besides easing the placing of the catheter, there is considerably less discomfort to the patient than with the standard tunneling procedure. Often, only a local anesthetic is required at the stab wound site. We have also noted less postoperative ecchymosis in the subcutaneous tunnel, which is especially important in the many patients with thrombocytopenia.
284
Summary A simplified technique to place the Hickman indwelling right atria1 catheter has been devised. This involves securing the catheter to a trocar, which is easily advanced to the cutdown site of the selected vein. Experience in more than 75 patients shows this technique to be associated with less discomfort and fewer complications than seen with standard techniques.
References 1. Heimbach DM, lvey TD. Technique for placement of a permanen? home hyperalimentation catheter. Surg Gynecol Obstet 1976:143:634-6. 2. Hickman RO. Buckner CD, Clift RA, Sanders JE, Stewart P, Thomas ED. A modified right atrial catheter for access to the venous system in marrow transplant recipients. Surg Gynecol Obstet 1969;148:871-5. 3. Bjeletich J, Hickman RO. The Hickman indwelling catheter. Am J Nursing 1980;80:62-5.
The American Journal of Surgery