Tunneled central venous catheter

Catheter device selection is based on a number of factors, including the plarmed application and placement site, duration of implantation, composition of fluids infused, and frequency of access (Namyslowski and Patel, 1999). Vascular catheters can be divided into two genei groups shortterm, temporary catheters that are placed percutaneously, and long-term, indwelling vascular catheters that usually require a surgical insertion. Temporary catheters include short peripheral venous and arterial catheters, nontunneled central venous and arterial catheters, and peripherally inserted central catheters (Pearson, 1996). Tunneled central venous catheters and totally implantable intra-... 

Dialysis vascular access is currently the lifeline for hemodialysis patients. Unfortunately, due to the many complications associated with dialysis vascular access, it is also the Achilles heel of hemodialysis. A relatively ignored aspect of dialysis vascular access pertains to patient safety. The first part of this chapter will describe patient safety issues in the traditional context of arteriovenous fistulas (AVFs), arteriovenous grafts (AVGs) and tunneled central venous catheter (tCVC). In the second half of this chapter, however, we will make the case that a nontraditional approach which emphasizes (a) individualization of care, and (b) patient preferences and patient involvement maybe our best opportunity to improve patient safety in hemodialysis patients. 

Ash SR Advances in tunneled central venous catheters for dialysis design and performance. Semin Dial 2008 21 504-515. 

Central venous catheters vary in composition, lumen size, number of injection ports, and other special features that affect ease or convenience of care and maintenance. They may be placed for shorter long-term access. Frequently, short-term central venous access is obtained in critically ill neonates via a catheter placed in the umbilical vein. ° Other sites for central venous access in infants and older children are similar to those in adults. When therapy is expected to last longer than 4 weeks, the catheter usually is tunneled subcutaneously before entering the central vessel, secured initially with retaining sutures, and anchored in place with a felt cuff that promotes the growth of subcutaneous flbrotic tissue around the catheter. The injection port may remain external or be concealed entirely beneath the skin. Implanted central venous catheters have a larger port or reservoir that is surgically placed beneath the skin surface and anchored in the muscle of the chest wall. 

Gray, R. J., Levitin, A., Buck, D., Brown, L. C., Sparling, Y. H., Jablonski, K. A., Fessahaye, A., and Gupta, A. K., Percutaneous fibrin sheath stripping versus transcatheter urokinase infusion for malfunctioning well-positioned tunneled central venous dialysis catheters A prospective, randomized triaL /- Vase. Interv. Radiol., 2000 11(9) 1121-1129. 

Central venous catheters (tunneled. Administration of medication or fluids... 

Many different types of venous-access devices are available. Peripherally inserted central venous catheters (PICCs), which can be made of PU or silicone, are inserted into a vein in the arm rather than in the neck or chest. Nontunneled CVCs are shortterm catheters, made of PU or silicone as well, inserted into the internal jugular, subclavian, or femoral vein. Tunneled CVCs are long-term catheters implanted surgically under the skin. One end of the catheter remains outside the skin and the exit site is typically located in the chest. Passing the catheter under the skin helps to reduce the infection risk and provides stability. Implantable ports are similar to tunneled catheters but are left completely under the skin. They consist in small devices, made of plastic or titanium, inserted beneath the skin and connected to a catheter allowing vascular access. Under the skin, the port has a septum through which drugs can be injected and blood samples can be withdrawn. 

If a centrally placed venous catheter is required, tunnelling of the catheter under the skin from the entry point to the appropriate vein minimizes the risk of infection,... 

Long-term central venous access devices used for chemotherapy can be categorized into peripherally inserted central catheters (PlCCs), chest wall external catheters (tunneled and non-tunneled), and subcutaneous ports (chest wall and extremity). 

Torosian MH, Meranze S, McLean G, Mullen JL (1986) Central venous access with occlusive superior central venous thrombosis. Ann Surg 203 30-33 Trerotola SO, Johnson MS, Harris VJ, Shah H, Ambrosius WT, McKusky MA, Kraus MA (1997) Outcome of tunneled hemodialysis catheters placed via the right internal jugular vein by interventional radiologists. Radiology 203 489-495... 

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