Background and methods: Increased utilization of central venous catheters for hyperalimentation has caused a rise in the incidence of central venous complications including occlusions and stenoses. When this occurs, the continued use of these catheters becomes more difficult. We describe a technique for catheter placement in a patient requiring access for total parenteral nutrition who had extensive central venous occlusion involving both internal jugular veins, both subclavian veins, and the infrorenal inferior vena cava (IVC).
Results: A percutaneous transhepatic venous catheter had been placed in a patient with inferior vena caval, subclavian, and internal jugular venous occlusions. The Hickman catheter functioned well until the patient developed fungal sepsis and a large fibrin sheath around the catheter tip creating the need for a new access site. Placement of an intercostal venous catheter was performed using transhepatic venography to map patent collateral veins and microcatheters to access an intercostal route for Hickman placement.
Conclusions: Patients who require long-term central venous access often develop stenotic and occlusive complications in the central venous circulation. Individualized, unique and innovative routes to the central venous circulation must often be utilized to maintain venous access in these patients. Transhepatic venous mapping and microcatheter techniques aid in the finding of alternative sites in these patients with difficult access problems.