title: A comparative analysis of radiological and surgical placement of central venous catheters.
abstract: OBJECTIVE
  To compare the differences in practice and outcome of all radiologically and surgically placed central venous catheters retrospectively over a 2-year period simultaneously, at a single institution.
  
  
  METHODS
  A total of 253 Hickman catheters were inserted in 209 patients; 120 were placed radiologically in 102 patients and 133 were placed surgically in 107 patients. The indication was chemotherapy in 76% of radiological and in 47% of surgical cases; the remainder were for total parenteral nutrition and venous access.
  
  
  RESULTS
  There were 6 (4.5%) primary surgical failures and a further 17 (13%) surgical cases requiring multiple placement attempts. Pneumothorax occurred once (0.8%) surgically and four times (3.3%) radiologically. There were no radiological primary misplacements but there were five (3.7%) surgical ones. Catheter or central vein thrombosis occurred in four (3.3%) radiological and five (3.7%) surgical cases. The rate of infection per 1000 catheter-days was 1.9 in radiologically placed catheters and 4.0 in surgically placed ones (p < 0.001). Average catheter life-span was similar for the two placement methods (100 +/- 23 days).
  
  
  CONCLUSIONS
  Radiological placement is consistently more reliable than surgical placement. There are fewer placement complications and fewer catheter infections overall.
authors.affiliation: Department of Radiology, Royal Hallamshire Hospital NHS Trust, Sheffield, United Kingdom.
authors.forename: K D
authors.initials: KD
authors.lastname: McBride
authors.forename: R
authors.initials: R
authors.lastname: Fisher
authors.forename: N
authors.initials: N
authors.lastname: Warnock
authors.forename: D A
authors.initials: DA
authors.lastname: Winfield
authors.forename: M W
authors.initials: MW
authors.lastname: Reed
authors.forename: P A
authors.initials: PA
authors.lastname: Gaines
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010289:Parenteral Nutrition, Total / Q000295:instrumentation; D010348:Patient Care Team; D015642:Radiology, Interventional; D013350:Subclavian Vein; D016896:Treatment Outcome; D016748:Venous Cutdown
chemical_list: D000970:Antineoplastic Agents