The Removal of Central Venous Silicone Rubber Catheters-Reply

In Reply.— The letters of Drs Poliakoff and Powell clearly state that indwelling central venous silicone rubber catheters (eg, Hickman and Broviac) should not be removed by the application of traction at the exit site but rather should be removed surgically by a small incision over the Dacron cuff followed by appropriate limited dissection. Dr Hickman, however, has recommended that the catheters be removed with the application of "firm and steady" traction at the exit site, and that this procedure can be performed without complication in the majority of patients. 1 He recommends surgical removal of the catheter only if traction removal is difficult or if the catheter breaks. The appropriate removal technique would seem to lie somewhere between these two approaches. It would seem unnecessary, in view of the vast experience with traction removal, to resect surgically all indwelling silicone rubber catheters. I feel that surgical removal of retained