"Cuff-stitch" to prevent inadvertent dislodgement of central venous catheters

Early cuff anchorage for tunneled central venous catheters using a buried absorbable suture

PURPOSE

Long-term tunneled cuffed central venous catheters (CVC) are widely used for the administration of chemotherapy, parenteral nutrition, and fluids. External migration and displacement of catheters have been reported to occur in 2.4% to 24% of cases, prompting the development of various anchoring strategies. We report an adaptation of previous techniques, where the cuff of a tunneled catheter is prevented from moving outwards by inserting a buried absorbable purse string suture around the catheter. Its effectiveness in catheter fixation has been assessed in a prospective audit.

METHODS

The effectiveness of the anchoring suture was assessed in a cohort of 101 oncology chemotherapy patients using specific measurements of catheter movement (Dacron cuff to suture distance, Dacron cuff to exit site distance, and external catheter length), taken at catheter insertion and removal.

RESULTS

Catheters were placed in situ for a median of 16 weeks. Displacement was found in 19% to 36% of lines (depending on the specific measurement taken), with a median cuff to exit site movement of 7.5 mm (range 5 to 40 mm) and a median length of external line movement of 10 mm (range 5 to 70 mm). The suture had good cosmetic results.

CONCLUSIONS

This is, to our knowledge, the first study to attempt to quantify CVC movement. Our data suggest that this suture technique provides an effective and safe additional strategy for cuffed tunneled CVC fixation.

Incidence of indwelling central venous catheter-related complications using the Sri Paran technique for device fixation in children with cancer

PURPOSE

Mechanical complications in tunneled indwelling central venous catheters (CVCs) often involve a risk of displacement. Fixation procedures are, therefore, of primary importance. We prospectively evaluated the incidence of CVC-related mechanical and infectious complications observed in devices fixated with the Sri Paran technique.

METHODS

All CVCs inserted in children with cancer at our Institution from October 2005 to January 2007 were prospectively monitored for device-related mechanical and infectious complications. The Sri Paran fixation technique was used in all cases. The complication rate per 1,000 days was calculated as 1,000 times the number of complications divided by the total number of catheter days.

RESULTS

Ninety-five CVCs were positioned in 84 children. The overall length of observation ranged between 41 and 482 days for a total of 18,618 catheter days. Mechanical complications occurred in 5% of the devices (specific rate 0.27); infections were observed in 6% of the devices (specific rate 0.32). No complications were observed during the first 30 days after CVC insertion.

CONCLUSIONS

The results, we obtained with the Sri Paran technique are extremely encouraging. Yet, randomized studies are required to prove these preliminary data.

A single institution observational study of early mechanical complications in central venous catheters (valved and open-ended) in children with cancer

The use of indwelling central venous catheters (CVCs) has become essential for managing children undergoing cancer treatment. Various types of CVCs are available, but reports on complications observed in pediatric series are scarce. We describe our experience concerning early mechanical complications at our institute by providing a prospective evaluation of three types of CVCs that were inserted over a 39-month period. Between January 1, 2000, and March 31, 2003, double-lumen (DL) or single-lumen (SL) Hickman-Broviac (HB) and single-lumen pressure-activated safety-valved (PASV) catheters were inserted and prospectively evaluated. Five groups of possible mechanical complications were defined a priori: dislodgement, migration, rupture, accidental removal, and blockage. We took into consideration complications occurring only within the first 30 days of insertion. A total of 272 CVCs (118 PASV, 57 DL-HB, and 97 SL-HB) were inserted in 232 children. A total of 29 early mechanical complications (10.7% of all CVCs) were diagnosed: 15.2% of the PASV, 10.5% of the DL-HB, and 4.1% of the SL-HB. Elective removal of the catheter due to complications was required in eight patients. SL-HB catheters had fewer complications, while the complication rate and the number of devices that were removed were significantly higher in patients with PASV catheters. We conclude that catheter type correlates with the risk of early mechanical complications and removal.