Safe removal of long-term cuffed Hickman-type catheters

Safe removal of long-term venous catheters in the neck

AIMS

Tunnelled venous catheters are a well-established method of long-term venous access for total parental nutrition, chemotherapy and antimicrobial treatment. Removal of these catheters is a simple procedure; however, there are some significant risks.

METHODS

We report a case in which a serious complication occurred. A simple technique for the safe removal of long-term venous catheters is described.

CONCLUSION

A direct surgical removal is now generally favoured for safe line removal. However, this still carries the same complications and care must be taken in the technique.

A review of an anaesthetic led vascular access list

The demand for insertion of long-term central venous (Hickman type) catheters is thought to be increasing. Organisation is required to meet this demand in a safe and efficient manner. This report reviews the results from a dedicated, anaesthetic led vascular access list over the initial 61-month period. One thousand procedures were performed. Nine hundred and twenty catheters were inserted under local anaesthesia, with or without intravenous sedation and analgesia. Eighty catheters were removed. All procedures were performed during a dedicated once weekly, morning list. A total of 53% of all procedures were performed on a day-case basis, 43% on in-patients. Only 1.5% of patients required an unexpected overnight stay (usually medically unfit patients). There were 81 (9%) cancellations on the day of procedure due to neutropaenia, pneumonia or urinary tract infections. Ultrasound guidance was used initially selectively in 14%, latterly in 100% of procedures and fluoroscopy in all insertions to confirm or adjust catheter position. This service has been well received by patients and oncology services. In addition it provides an interesting area of practice for anaesthetists and an ideal environment for teaching more advanced aspects of central venous access. It may provide a template of service for other centres.

Technical report: use of ultrasound guidance in the removal of tunnelled venous access catheter cuffs

Venous access catheters are employed for a wide variety of reasons. On removal of the catheter, the subcutaneous catheter cuff can be difficult to extract; retention of the cuff has recognized complications. We describe a simple ultrasound technique that assists in the identification of the cuff within the subcutaneous tissues, simplifying subsequent cuff removal. This may lead to a reduction in associated complications.

Provision of long-term venous access procedures by UK anaesthetists: A postal survey

Long-term venous access is widely used in hospital and in the community for cancer chemotherapy, total parenteral nutrition and long-term administration of antibiotics. There is a large variety of catheters, ports and other devices designed to facilitate these treatments. A postal survey of anaesthetic departments in England, Wales, Scotland and Northern Ireland was undertaken to assess the role of anaesthetists in this area of clinical practice. Two hundred and fifteen out of 276 (78%) anaesthetic departments responded. Forty-three percent of departments (92 out of 215) provided some form of long-term vascular access service. Twenty-two percent of departments which provided this service (20 out of 92) had anaesthetists with sessional allocation for such procedures. Such work represents a significant workload for anaesthetic departments which is likely to increase over time.