title: Percutaneous, tunneled silicone elastomer central venous catheters for total parenteral nutrition: low sepsis and thrombosis rate. A prospective study of 315 catheters.
abstract: Silastic catheters were inserted by the percutaneous route, and tunneled subcutaneously, in 315 patients who needed venous access for total parenteral nutrition. The catheters were managed with a daily program that included heat sterilization of the metal hub with an electrical soldering iron. This study aimed to evaluate prospectively the incidence of catheter-related sepsis and thrombosis. There was one case of pneumothorax. All catheters were x-rayed post-insertion: eight catheters were malpositioned initially. The median catheter duration was 18 days with a range of 2-138 days. The total duration was 240 catheter-months. Twenty-seven catheters were removed due to mechanical problems. Nine were removed because of suspected sepsis; six patients had negative blood and catheter cultures, while three grew pathogens. The sepsis rate was thus 0.95%. There were no clinical signs of thrombosis. Pull-out venography was performed in 93 patients. Fibrin sleeves were seen in the majority of cases. Two patients had wall-adherent, non-occlusive thrombus masses (2%); they both had proximal catheter positions. We conclude that there is a low risk of catheter-related sepsis and thrombosis with this technique.
authors.affiliation: Department of Anesthesiology, University Hospital, Linköping, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Sandstedt
authors.forename: F
authors.initials: F
authors.lastname: Hesselvik
authors.forename: T
authors.initials: T
authors.lastname: Marklund
authors.forename: G
authors.initials: G
authors.lastname: Stenport
mesh_terms: D000328:Adult; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D007239:Infections / Q000209:etiology; D010289:Parenteral Nutrition, Total / Q000009:adverse effects / Q000295:instrumentation*; D011446:Prospective Studies; D012826:Silicone Elastomers; D013924:Thrombophlebitis / Q000209:etiology
chemical_list: D012826:Silicone Elastomers