title: Malpositioning of Hickman catheters, left versus right sided attempts.
abstract: BACKGROUND
  Central venous catheters (CVC) are frequently used for stem cell collection and recurrent therapeutic hemapheresis procedures for patients with poor peripheral venous access. There is a tendency to prefer a right sided approach for insertion of a CVC via the subclavian route. We designed a sequential randomized study to examine the issue of catheter insertion side and analyzed all the technical data on surgical skill and observed complications.
  
  
  METHODS
  Seventy-five patients who are candidates for stem cell collection and high dose chemotherapy underwent placement of Hickman catheters via the percutaneous subclavian vein (SCV) route. One experienced surgeon inserted 12F, double lumen, tunnelled, silicon based catheters in the operation room via fluoroscopic control. All of the procedure related complications, morbidity and mortality were analyzed on the basis of the side of catheter insertion.
  
  
  RESULTS
  The total rate of malpositioning in this series was 14.66%. The Jugular vein was the most common malpositioning site (66.6%). We observed a statistically significant difference in malpositioning between left versus right sided attempts, at 5.55% versus 20.51%, respectively (p = 0.032). The routes of malpositioning encountered for left sided attempts were the right SCV and the left internal jugular vein, the right internal jugular vein (n = 5), the left SCV vein (n = 2), and one left internal jugular vein. There was no significant difference between the right and left sided attempts for mechanical complications other than malpositioning (p < 0.05).
  
  
  CONCLUSIONS
  In this study the rate of malpositioning was greater in the right sided approach (p = 0.032) and the other mechanical complication rates did not differ for the two methods. Our results indicate that there is no need for hesitancy in using left sided attempts at CVC insertion.
authors.affiliation: Department of General Surgery, Section of Surgical Oncology, Ankara University Medical School, Ahmet Rasim sok 35/6, Cankaya, Ankara 06550, Turkey. ekremunal@hotmail.com
authors.forename: Ali Ekrem
authors.initials: AE
authors.lastname: Unal
authors.forename: Sancar
authors.initials: S
authors.lastname: Bayar
authors.forename: Mutlu
authors.initials: M
authors.lastname: Arat
authors.forename: Osman
authors.initials: O
authors.lastname: Ilhan
mesh_terms: D000293:Adolescent; D000328:Adult; D001781:Blood Component Removal / Q000379:methods; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D002408:Catheters, Indwelling / Q000009:adverse effects; D005260:Female; D006801:Humans; D007601:Jugular Veins; D008297:Male; D019300:Medical Errors / Q000706:statistics & numerical data; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy; D013350:Subclavian Vein