Lingegowda Dayananda, Gehani Anisha, Sen Saugata, Mukhopadhyay Sumit, Ghosh Priya
Tata Medical Center, Kolkata, India.
J Vasc Access. 2020 Sep;21(5):773-777. doi: 10.1177/1129729820909028. Epub 2020 Mar 5.
Vascular access in oncology patients can often be challenging, especially after a few cycles of chemotherapy through peripheral lines which can cause veins to become attenuated. We evaluated the feasibility of centrally placed non-cuffed tunnelled peripherally inserted central catheter in the chest as an alternative to conventional peripherally inserted central catheter.
Patients referred for peripherally inserted central catheter found to have inadequate peripheral venous access in their arms due to prior chemotherapy, and therefore they were offered placement of the non-cuffed tunnelled peripherally inserted central catheter in the chest. Adult patients were subjected to the procedure under local anaesthesia, while paediatric patients underwent this procedure under general anaesthesia. Ultrasound guidance was used for venous access, and fluoroscopy was used for tip positioning. Using internal jugular vein access, BARD Groshong-valved 4F peripherally inserted central catheter was placed with its tip in the cavo-atrial junction. Proximal end of the catheter was brought out through the subcutaneous tunnel, so that the exit point of the peripherally inserted central catheter lies over the upper chest. Extra length of the catheter was trimmed, and extensions were attached. The device was stabilized with adhesive and sutures.
Out of 19 patients, 18 patients were male (4-72 years). Technical success was achieved in 100% cases. No catheter-related bloodstream infection was noted within 30 days of peripherally inserted central catheter. Overall, during 1966 catheter days, no catheter-related bloodstream infection was observed. The purpose of peripherally inserted central catheter was achieved in 15 patients (78.9%) either in the form of completion of chemotherapy (8/15) or maintained peripherally inserted central catheter line till death (7/15). Partial or complete pullout was observed in four patients (20.1%), which required cuffed tunnelled catheter or implantable port. External fracture was noted in one patient, which was successfully corrected using repair kit. No exit site infection, bleeding, catheter occlusion, catheter dysfunction, venous thrombosis, venous stenosis or catheter embolizations were noted in our series.
Centrally placed tunnelled peripherally inserted central catheter is a promising alternative method, when conventional arm peripherally inserted central catheter placement is not feasible. It is an easy and safe procedure that can be performed under local anaesthesia.
肿瘤患者的血管通路建立常常具有挑战性，尤其是在通过外周静脉进行几个周期的化疗后，外周静脉可能会变细。我们评估了在胸部置入非带 cuff 的隧道式外周静脉中心导管作为传统外周静脉中心导管替代方案的可行性。
因先前化疗导致手臂外周静脉通路不佳而转诊至外周静脉中心导管置入的患者，被提供在胸部置入非带 cuff 的隧道式外周静脉中心导管。成年患者在局部麻醉下接受该操作，而儿科患者在全身麻醉下进行。超声引导用于静脉穿刺，透视用于尖端定位。通过颈内静脉穿刺，将 BARD Groshong 瓣膜 4F 外周静脉中心导管置入，尖端位于腔房交界处。导管近端通过皮下隧道引出，使外周静脉中心导管的出口位于上胸部。修剪导管多余长度并连接延长管。用粘合剂和缝线固定该装置。
19 例患者中，18 例为男性（4 - 72 岁）。100%的病例技术成功。在外周静脉中心导管置入后 30 天内未发现导管相关血流感染。总体而言，在 1966 个导管日期间，未观察到导管相关血流感染。15 例患者（78.9%）实现了外周静脉中心导管的目的，其中 8 例完成化疗，7 例直至死亡维持外周静脉中心导管通路。4 例患者（20.1%）出现部分或完全拔出，需要带 cuff 的隧道式导管或植入式端口。1 例患者出现外部断裂，使用修复套件成功纠正。本系列中未发现出口部位感染、出血、导管堵塞、导管功能障碍、静脉血栓形成、静脉狭窄或导管栓塞。
当传统的手臂外周静脉中心导管置入不可行时，在胸部置入隧道式外周静脉中心导管是一种有前景的替代方法。这是一种简单且安全的操作，可在局部麻醉下进行。
