Real-time ultrasound-guided supraclavicular technique as a possible alternative approach for Hickman catheter implantation
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In brief
In brief
Case report describing successful real-time ultrasound-guided supraclavicular approach for Hickman catheter placement in a 1-year-old after bilateral subclavian vein failure. The technique offers an alternative route when traditional subclavian or jugular access is unavailable due to thrombosis or stenosis from prior attempts.
Written by the GCMD Library team from the article.
Background
Tunneled Hickman/Broviac central venous catheter implantation is performed when patients require a central vein route for long-term therapy. The subclavian or internal jugular vein approach is often chosen for their implantation sites. However, access to the central vein can be difficult owing to thrombosis or stenosis when the same vein has already been accessed several times. In such situations, other possible alternative approaches to the central vein should be considered to avoid serious complications owing to further unsuccessful attempts.
Description of operative technique
We encountered a 1-year-old patient admitted to our hospital for a Hickman catheter implantation after multiple unsuccessful attempts at central venous catheter insertion via bilateral subclavian approaches in another hospital. An ultrasound showed that no more subclavian veins were available on either side. A real-time ultrasound-guided right supraclavicular approach was performed as a solution to this situation.
Conclusions
In this article, we introduce a real-time ultrasound-guided supraclavicular approach as a possible alternative method for Hickman catheter implantation. We present step-by-step instructions including figures and a video and further discuss the advantages and disadvantages of this procedure, comparing the right and left approaches with references to existing literature.
Level of evidence
Level I.