A new technique for placement of tunneled subclavian right atrial catheters: experience with 130 cases.

We have developed a new single step technique for placement of indwelling silastic subclavian right atrial catheters through a short subcutaneous tunnel that is simple, relatively inexpensive, and can be done in the outpatient clinic. Between December 1984 and July 1986, 130 catheters were inserted in 122 patients using this approach for a cumulative total of 8,900 catheter days. Major complications have included five catheter infections with bacteremia, two procedure-related pneumothoraces, one internal jugular vein thrombosis, and one catheter fragment embolization to the right heart (total major complication rate, 6.9%). Minor complications have included five catheter migrations, seven catheter or catheter hub leaks, and two irreversible lumen occlusions (total minor complication rate 10.8%). Damaged or malpositioned catheters can be replaced through the same subcutaneous tract using a guidewire exchange technique. When this has not been possible, we have not encountered technical difficulties (due to subclavian thrombosis or stenosis) prohibiting insertion of a new catheter, even on the same side. These catheters provide reliable venous access for patients requiring frequent blood sampling, intravenous (IV) fluid or blood product administration, chemotherapy, IV narcotics for pain control, long-term antibiotic therapy, or hyperalimentation. They are ideal for infusion of vesicant chemotherapeutic agents and for patients undergoing ambulatory outpatient infusion chemotherapy. They have a low overall morbidity rate and excellent patient acceptance. Catheter maintenance procedures are simple and non-time-consuming. The same technique can be used to place multichannel catheters in patients requiring greater venous access. We now recommend early placement of these catheters in patients who will require frequent phlebotomy or drug administration during the course of their treatment.