To the Editor.—The well-illustrated technique describing the percutaneous insertion of a permanent hyperalimentation catheter (Archives 1982; 117:976-977) should be appreciated by all surgeons involved in the placement of such catheters.
One additional modification of the technique, which I have used, involved the tunnel through which the Hickman catheter is brought. Use of a sterile metal knitting needle to connect the two incisions and create a tunnel has a few advantages: (1) less discomfort is involved compared with the use of a long clamp; (2) smaller incisions are needed to pass the knitting needle through compared with the clamp; and (3) there is less chance of bleeding because the tunnel that is created is smaller.
As I and my co-workers have reported separately,1 the percutaneous subclavian technique has a multitude of advantages and, therefore, is recommended highly as the preferred route for Hickman catheter insertion.
RUBENSTEIN RB. Catheter Insertion. Arch Surg. 1983;118(1):129. doi:10.1001/archsurg.1983.01390010095027