Minimally Invasive Tumor Therapy (MITT)

Department of Radiology, Charité – Universitätsmedizin Berlin

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References

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Tunneled Central Venous Catheters

 

There are central venous catheter (CVC) variants which, similar to non-tunneled CVCs, are advanced so that their tip will be near or in the right atrium of the heart. However, they differ in that they can stay in the body longer (typically 3 - 12 months or sometimes even longer; versus about 2 weeks for a non-tunneled CVC). Hence, these catheters offer advantages to hemodialysis patients who may require lifelong hemodialysis and thus are in need of an access that can be used several times a week and is low in complications. In order to ensure a long indwelling time of the catheter, potential colonization with germs (pathogens) should be prevented or at least delayed.

 

The different types of tunneled CVCs (Hickman, Broviac, and Demers) share two important properties, which distinguish them from conventional CVCs and which are intended to prevent the invasion of infectious agents:

 

  1. A longer passage beneath the skin (subcutaneous) from the site of entry into the body and the site of entry into the vein is intended to make it more difficult for pathogens from outside the body to reach the bloodstream. This subcutaneous passage or tunnel gives the catheter its name. It helps to reduce the risk of systemic infection, which may occur when pathogens enter the blood and spread throughout the body.
  2. A cuff made of polyester fibers (Dacron) is attached at the shaft of the catheter (over a 1-cm segment) along its subcutaneous course to serve as an additional barrier against pathogen migration. Over time, the Dacron cuff is overgrown with the fatty tissue underneath the skin and thus additionally helps to keep the catheter in place and to prevent accidental displacement (dislocation). For additional protection, the polyester cuff may be impregnated with antibiotic or antibacterial material (e.g., silver ions).

 

The following types of tunneled catheters are implanted by interventional radiologists of our department:

 

What are the Risks of Implantation?

 

The combined use of ultrasound to guide venous puncture and X-ray images to observe advancement and positioning of the catheter allows interventional radiologists to reduce the risks associated with CVC implantation to a very low level. This is the safest method for placing a tunneled CVC. Possible risks of central venous catheterization include bleeding and hematoma (bruise), accidental puncture of the cervical or subclavian artery, infection or abscess formation, thrombosis of the vein or catheter, escape of air into the pleural cleft (pneumothorax), and injury of neighboring organs.