Tunneling the central venous catheter from the venous insertion site in the subclavicular or cervical area to the exit site on the chest wall can be difficult, especially in small children with a very convex chest wall. We present a technique which avoids many of the problems encountered with previously described methods.
Get full access to this article
View all access options for this article.
References
1.
Ross AHM , Anderson JR, Walls ADF : Central venous catheterisation. Ann R Coll Surg Engl62:454-458, 1980
2.
Peters JL, Belsham PA: Tunnelling techniques. IN A Manual of Central Venous Catheterization and Parenteral Nutrition, Peters JL (ed). Wright PSG, Bristol , 1983, pp 89-110
3.
Keohane PP, Jones BJM, Attrill H., et al: Effect of catheter tunnelling and a nutrition nurse on catheter sepsis during parenteral nutrition: a controlled trial. Lancet2:1388-1390, 1983
4.
Mitchell A., Atkins S., Royle GT, et al: Reduced catheter sepsis and prolonged catheter life using a tunnelled silicone rubber catheter for total parenteral nutrition. Br J Surg69:420-422, 1982
5.
Sitges-Serra A., Linares J.: Tunnels do not protect against venous-catheter-related sepsis. Lancet1:459-460, 1984
6.
Van Meyenfeldt MMF , Stapert J., De Jong PCM, et al: TPN catheter sepsis: lack of effect of subcutaneous tunnelling of PVC catheters on sepsis rate. JPEN4:514-517, 1980
7.
Benotti PN, Bothe A., Blackburn G.: Safe cannulation of the internal jugular vein for long-term hyperalimentation . Surg Gynecol Obstet144:574, 1977
8.
Parsa M., Ferrer J. (ed): Safe central venous nutrition: Guidelines for the prevention and management of complications. Charles C Thomas, Springfield, IL: 1974
9.
Solassol C., Joyeux H., Etco L., et al: New techniques for long-term intravenous feeding: an artificial gut in 75 patients. Ann Surg179:519-522, 1974
10.
Powell-Tuck J.: A skin tunnel for central venous catheter: non-operative technique. Br Med J1:625, 1978
11.
Titone C., Lefton C., Sakwa S.: A technique for chronic subclavian vein catheterisation. Surg Gynecol Obstet137:489-490, 1973
12.
Older PO, Levitt M.: A technique for subcutaneous tunnelling of a subclavian catheter. Anaesth Intensive Care9:60-63, 1981
13.
Keilly E.: Placement of central feeding catheters. Br Med J2:1123, 1978
14.
Heimbach DM , Ivey TD: A technique for placement of a permanent home hyperalimentation catheter. Surg Gynecol Obstet143:635, 1976
15.
Riella MC, Scribner BH: Five years' experience with a right atrial indwelling catheter for prolonged parenteral nutrition at home. Surg Gynecol Obstet143:205, 1976
16.
Raaf JH, Callery C.: An easy technique for tunnelling the Broviac catheter. Surg Gynceol Obstet157:485-486, 1983
17.
O'Donnell JJ , Claque MB, Dudrick SJ: Percutaneous insertion of a cuffed catheter with a long subcutaneous tunnel for intravenous hyperalimentation . South Med J11:1344-1348, 1983
18.
Reed WP, Newman KA: An improved technique for the insertion of Hickman catheters in patients with thrombocytopenia and granulocytopenia. Surg Gynecol Obstet156:355-358, 1983
19.
Tonkin PA, Smith GB, Grimes AP: A subcutaneous tunnelling device for central venous catheters. Anesthesia39:196-197, 1984