title: Usefulness of exchanging a tunneled central venous catheter using a subcutaneous fibrous sheath.
abstract: OBJECTIVE
  The reserve of the venous route to the central veins is important for long-term parenteral nutrition (PN). Frequent catheter-related bloodstream infection (CRBSI) induces occlusion of the venous routes. Therefore, a modified exchange procedure using a tunneled central venous catheter (CVC) with a fibrous sheath was developed to preserve the route to the central veins.
  
  
  METHODS
  Seven patients who required long-term PN received the modified exchange procedure and the outcome of exchanged CVC was retrospectively reviewed.
  
  
  RESULTS
  The procedure was performed 10 times in seven patients. The venous routes were either the subclavicular or the internal jugular vein in all patients. The exchange of the catheter was due to CRBSI or occlusion in almost all patients. The mean duration of new catheter use was 296.2 days following the exchange. Four catheters continued to be used, and the remaining ones were removed. The reasons for removal were severe CRBSI and occlusion, each of which occurred in two catheterized patients, while the reason for removing the remaining catheters was because the patients no longer needed the catheters.
  
  
  CONCLUSIONS
  The modified catheter exchange using fibrous sheath, even in patients with CRBSI, appears to be an effective procedure for reserving the venous route to the central veins in patients who require either long-term PN or other treatments.
authors: Department of Pediatric Surgery, Reproductive and Developmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. kmasu@pedsurg.med.kyushu-u.ac.jp
authors: Kouji
authors: K
authors: Masumoto
authors: Genshiro
authors: G
authors: Esumi
authors: Risa
authors: R
authors: Teshiba
authors: Kouji
authors: K
authors: Nagata
authors: Tomoaki
authors: T
authors: Taguchi
mesh_terms: D000328:Adult; D055499:Catheter-Related Infections / Q000209:etiology / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation*; D002408:Catheters, Indwelling; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D055104:Infusions, Subcutaneous / Q000379:methods*; D008297:Male; D010288:Parenteral Nutrition / Q000592:standards*; D018805:Sepsis; D013997:Time Factors