Translumbar inferior vena cava catheters for long-term venous access.

Forty-six silicone rubber catheters were placed in the inferior vena cava (IVC) of 40 patients via a translumbar approach. No patient suffered retroperitoneal bleeding as determined by means of clinical observation (n = 46), computed tomography (CT) (n = 31), or autopsy (n = 5). Twenty-four catheters were removed after a mean of 51 (range, 2-137) days. No bleeding occurred after catheter removal, as determined by means of clinical observation (n = 24), CT (n = 13), or autopsy (n = 2). Nineteen catheters remained in place after a mean of 65 (range, 13-236) days. Thrombosis-related catheter dysfunction occurred in eight patients, two of whom developed IVC occlusion. Thrombolytic therapy restored catheter function and dissolved clots in all patients. Ten catheter malpositions resulted in venous access failure. Five of these catheters were replaced, four were repositioned, and one spontaneously resumed the original position. It is concluded that percutaneous placement of silicone rubber catheters in the IVC is a satisfactory alternative when catheter placement in the subclavian vein is not feasible.