Tunneles chest wall external catheter

Tunneled chest wall external catheters are the prototypical chemotherapy external device. They are available with single, dual or triple lumen, end-hole or valved-tipped, and made from silicone or polyurethane material. Each device has a tissue ingrowth cuff attached to the portion of the catheter shaft that is situated within the subcutaneous tunnel (Jaques et al. 1989). This subcutaneous tunnel provides the necessary long-term stability and protection from infection. The cuff incites an ingrowth of fibrous tissue within 4-6 weeks, creating a long-term device that can be used for months to years (Fig. 6.2). 

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). 

Several factors influence the choice of a specific venous access device length and frequency of therapy patient comfort or activity ability to care for the device personal preference (physician, nurse, home health care and patient). Devices suitable for intermediate lengths of treatment (weeks to months) include PICCs, non-tunneled, and tunneled chest wall catheters. Longer therapies (months to years) favor tunneled external chest wall catheters and subcutaneous ports. Daily access would favor an external... 

The insertion of all externally tunneled chest wall catheters requires three basic steps (1) venous access... 

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. 

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