Atrial catheter for prolonged chemotherapy

Tobramycin blood levels from an indwelling right atrial catheter

Indwelling right atrial catheters provide continuous access to the venous circulation for the purpose of long-term alimentation and blood collection. Two types of central venous systems are the Broviac and Hickman catheters. In general, the Hickman is more versatile, allowing easy blood sample collection, in addition to continuous intravenous fluid and drug administration. Two cases are presented where apparent erroneous tobramycin blood samples were collected through one of these catheter systems. One case compares Hickman tobramycin blood levels with standard peripheral venicollection. Possible ramifications and solutions to the problem are discussed.

Hickman-Broviac catheters. Indications and results

The records of 84 patients in whom 98 Hickman-Broviac catheters were inserted were reviewed. The most common indication for catheter insertion was for administration of parenteral nutrition. Forty-four patients (52 percent) had catheters inserted for chemotherapy or combined chemotherapy and parenteranal nutrition. Thirteen patients had Hickman-Broviac catheters inserted for the administration of antibiotics. The majority of the patients (56 percent) had malignant disease. The insertion of Hickman-Broviac catheters was uncomplicated, especially through the external jugular vein. Catheter-related complications occurred in 20 percent of the patients, but none were fatal. The most common complications were thrombotic catheter occlusion and catheter related sepsis. The catheter-related sepsis rate was 8/6,308 catheter-days. These rates compare favorably with those reported by other investigators. Any patient with potential vascular access difficulty or obliterated or thrombosed veins who requires parenteral medication should be considered a candidate for insertion of a Hickman or Broviac catheter.