title: Sonographically guided venous puncture and fluoroscopically guided placement of tunneled, large-bore central venous catheters for bone marrow transplantation-high success rates and low complication rates.
abstract: OBJECTIVE
  Traditionally, large lumen, tunneled central venous catheters have been implanted by surgeons. We used a technique of sonographically guided jugular venous puncture and fluoroscopically guided catheter placement to achieve a high rate of technical success and to reduce complication rates.
  
  
  METHODS
  Between June 2002 and December 2006, 186 Patients have been referred to the Radiology Department for 211 implantations of large-lumen, tunneled, central venous catheters. Insertions were performed under maximum sterile barrier in the angio suite using combined sonographic guidance for puncture of the internal jugular vein and fluoroscopy for placement of a triple lumen 12.5 F catheter (Hickman, BARD Murray Hill, NJ, USA). All interventions were performed under local anesthesia without need for anesthesiologic surveillance. Peri- and postinterventional complications were recorded using standardized international recommendations.
  
  
  RESULTS
  Catheter implantation was technically successful in 207 of 211 cases (98.1%). Technical failure resulted in four patients due to chronic occlusions of the superior vena cava. No major complications were recorded. Four (1.9%) accidental arterial punctures occurred peri-interventionally; 24 (11.4%) early complications (bleeding, dysfunction, catheter rupture, and infection) and ten (4.7%) late complications (infection, dysfunction) were recorded. A clinically suspected catheter infection required catheter removal in 21 (10%) cases; 11 of 13 non-infectious catheter complications (bleeding, dysfunction, rupture) could be treated successfully by interventional-radiological treatment.
  
  
  CONCLUSIONS
  Percutaneous implantation of large-lumen, tunneled, central venous catheters can be achieved with a high technical success rate and a low complication rate under combined sonographic and fluoroscopic guidance. In cases of mechanical complications, catheter rescue by interventional techniques is possible in the vast majority of cases.
authors.affiliation: Department of Radiology, Charité, Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany. bernhard.gebauer@charite.de
authors.forename: Bernhard
authors.initials: B
authors.lastname: Gebauer
authors.forename: Ulf Martin Karl
authors.initials: UM
authors.lastname: Teichgräber
authors.forename: Michael
authors.initials: M
authors.lastname: Werk
authors.forename: Alexander
authors.initials: A
authors.lastname: Beck
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Wagner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002405:Catheterization, Central Venous / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D015642:Radiology, Interventional; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional; D055815:Young Adult