Techniques, Materials, and Devices A Modified Method of Vascular Access System Implantation Using the Subclavian Vein

ABSTRACT. A new method of implanting vascular access systems using the Arrow Percutaneous Sheath Introducer Kit is described. The surgeon who frequently inserts these systems may find this technique to be a useful alternative in those patients in whom cutdowns were unsuccessful or in whom the percutaneous technique with a peel-away sheath is found to be difficult. (Journal of Parenteral and Enteral Nutrition 13:329-330, 1989) A number of companies have developed totally im-plantable central venous access systems for the longterm delivery of parenteral nutrition, antibiotics, blood prod-ucts, and cancer chemotherapeutic agents. These devices also provide an easily accessible port for sampling blood. Importance, benefits, reliability, safety, and acceptance of these access systems have been thoroughly docu-mented. 1-6 Venous cannulation can be performed by a cutdown of the cephalic, external jugular, internal jugu-lar, or saphenous vein.7-9 Another method of venous cannulation is by percutaneous puncture of the subcla-vian vein, and then introducing a peel-away sheath10-11 (Fig. 1). On occasion a problem is encountered using the peel-away sheath, specifically kinking of the sheath on the under surface of the clavicle and tearing of the tip of the sheath by the costoclavicular ligament. An alterna-tive percutaneous implantation technique using an Ar