Efficacy of same venous route Hickman catheter replacement in patients with intestinal failure

• Published in: Journal of the Formosan Medical Association Vol. 122; no. 5; pp. 419 - 426
• Main Authors: Koh, Chee-Chee, Tsai, Huang-Wen, Ha, Siu-Chung, Tsai, Ya-Hui, Chen, Yun
• Format: Journal Article
• Language: English
• Published: Singapore Elsevier B.V 01.05.2023; Elsevier
• Subjects: Catheterization; Catheterization, Central Venous; Central venous; Central Venous Catheters; Humans; Intestinal Failure; Retrospective Studies; Retrospective study; Retrospective study; Central venous; Catheterization; Intestinal failure
• ISSN: 0929-6646; 1876-0821
• DOI: 10.1016/j.jfma.2022.10.003

Periodical replacement of venous Hickman catheters is required for the nutritional care of patients with intestinal failure. The conventional de novo operation (DN-OP) involves inserting the catheter into a new venous tract in each replacement; however, this could result in fast consumption of functional central vessels in patients with intestinal failure. Recently, same-route operation (SR-OP) has been adopted as an alternative approach for retaining venous access. We conducted a retrospective study to compare the efficacy of Hickman catheters and the survival of venous vessels using two different operative strategies. Overall, 181 catheters were inserted, 109 using DN-OP and 72 using SR-OP. The mean catheter duration was 11.9 ± 8.8 months in the DN-OP group and 10.5 ± 5.6 months in the SR-OP group; the infection rate was 0.74 in the DN-OP group and 0.44 in the SR-OP group. The vein accesses used in these insertions (n = 113) were classified: the DN-vein group for veins accessed only by DN-OP (n = 75) and the SR-vein group for veins accessed by an initial DN-OP and subsequent SR-OPs (n = 38). Mean working duration per vein access was 12.3 ± 10.1 months in the DN-vein group and 28.2 ± 14.8 months in the SR-vein group (p < 0.001); mean infection-free duration was 11.4 ± 10.1 months in the DN-vein group and 27.7 ± 15.3 months in the SR-vein group (p < 0.001). Application of SR-OP in Hickman catheter replacement significantly extended the working duration of venous access by re-using the same venous route without compromising catheter efficacy in patients with IF having poor venous access.