Scheme for creating a subcutaneous tunnel to place an indwelling implantable central venous access system in the forearm.
We report a method that we have devised in which a secure subcutaneous tunnel is prepared during the placement of an indwelling central venous reservoir in the forearm. Subjects included 69 cases in which a procedure for implanting an indwelling reservoir in the forearm was performed between June 2006 and May 2007. For the subcutaneous tunnel, a 22-G Cathelin needle was advanced from the puncture site, turning toward the subcutaneous pocket side to the deep subcutaneous area. A 14-G Surflo IV catheter was then advanced along the 22-G Cathelin needle from the subcutaneous pocket. With the tip of the 14-G Surflo IV catheter emerging above the skin at the puncture site, the inner needle of the 14-G Surflo IV catheter and the 22-G Cathelin needle were removed. The catheter was passed through the outer 14-G Surflo IV catheter to emerge on the subcutaneous pocket site, then the outer needle of the Surflo catheter was also removed, and a connection to the port was made to create the subcutaneous tunnel. In all 69 cases, the subcutaneous tunnel in the forearm of the nondominant arm was successfully created within a short period of time (100% success rate). No problems were observed due to slack in the catheter until removal of the sutures 1 week later and for 3 months after treatment. With this method, we believe that a subcutaneous tunnel can be prepared in which the contained catheter has minimal freedom of movement, and which minimizes any damage induced by slack in the catheter within the subcutaneous tunnel.
Department of Radiology, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan. rad043@poh.osaka-med.ac.jp
Kazuhiro
K
Yamamoto
Masato
M
Tanikake
Hiroshi
H
Arimoto
Keita
K
Utsunomiya
Isamu
I
Narabayashi
Yoshifumi
Y
Narumi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000295:instrumentation / Q000379:methods*; D002408:Catheters, Indwelling; D005260:Female; D005542:Forearm / Q000098:blood supply*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional