Exchanging dual-lumen central venous catheters: how I do it

The management of a blocked long-term central venous catheter has traditionally been removal and re-siting, even when device failure is not associated with venous thrombosis or sepsis. It is not possible to 'railroad' a split dual-lumen central venous catheter down a long tortuous s.c. tunnel. Our exchange technique was designed to salvage the tunnel and venous access site in a long-term catheter that has had uncomplicated primary device failure. In this technique we divide the dual-lumen catheter and secure the venous access site and the s.c. tunnel with separate peel-away sheaths. The new catheter is then introduced in the conventional manner through the two peel-away sheaths, which are then removed. The key advantage of the technique is that it preserves one of the few central venous access sites available. This article describes exchange of an internal jugular catheter, but the same technique is applicable to subclavian catheters.