title: Early cuff anchorage for tunneled central venous catheters using a buried absorbable suture.
abstract: OBJECTIVE
  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.
authors.affiliation: Leeds General Infirmary, Leeds, UK. christopherramsey@doctors.org.uk
authors.forename: Christopher
authors.initials: C
authors.lastname: Ramsey
authors.forename: Hamish
authors.initials: H
authors.lastname: McClure
authors.forename: Bali
authors.initials: B
authors.lastname: Bhambra
authors.forename: Sarah
authors.initials: S
authors.lastname: Dolling
authors.forename: Andrew
authors.initials: A
authors.lastname: Bodenham
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D002408:Catheters, Indwelling / Q000009:adverse effects; D020878:Device Removal; D004739:England; D004867:Equipment Design; D005548:Foreign-Body Migration / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008485:Medical Audit; D008875:Middle Aged; D011093:Polyethylene Terephthalates; D011446:Prospective Studies; D013536:Suture Techniques; D013997:Time Factors; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D011093:Polyethylene Terephthalates