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Long-term vascular access via the inferior vena cava
1Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
Insights
The infraumbilical approach for long-term central venous access catheters is safe and effective. This method offers a viable alternative when the conventional supraumbilical route is challenging, demonstrating comparable outcomes.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Medical Devices
Background:
- Long-term central venous access is crucial for various medical treatments.
- Conventional supraumbilical catheter placement can be difficult or contraindicated in some patients.
- Evaluating alternative venous access routes is essential for patient care.
Purpose of the Study:
- To prospectively evaluate the efficacy and morbidity of long-term central venous access catheters placed via the inferior vena cava (IVC) using an infraumbilical approach.
- To compare the outcomes of infraumbilical IVC catheterization with the supraumbilical approach.
Main Methods:
- Prospective evaluation of 31 catheters placed in 26 patients between June 1987 and May 1989.
- Catheters were placed via an infraumbilical approach when the supraumbilical route was not feasible.
- Data collected on catheter use days, complications, and outcomes.
Main Results:
- A total of 3,503 catheter use days were recorded.
- 14 complications occurred in 12 episodes (1 per 701 catheter use days).
- Complications included catheter occlusion/thrombosis, malfunction, cuff erosion, and migration.
Conclusions:
- The infraumbilical approach for long-term central venous access via the IVC is safe and technically straightforward.
- This method is a valuable alternative for patients with difficult or high-failure risk supraumbilical access.
- The complication rates were comparable to those of the supraumbilical approach.
Abstract:
A prospective evaluation of long-term venous access catheters placed via the inferior vena cava was performed to determine their efficacy as well as short- and long-term morbidity. From June 1987 to May 1989, 31 catheters were placed in 26 patients, for a total of 3,503 catheter use days. All catheters were placed via an infraumbilical approach when the more conventional supraumbilical route was technically difficult, dangerous, or impossible to be used. There were a total of 14 complications in 12 episodes (one in every 701 catheter use days), six episodes of catheter occlusion or vessel thrombosis (one in every 583 catheter use days), one catheter malfunction, one episode of cuff erosion through the skin, and one catheter that migrated through the inferior vena cava into the retroperitoneum. These results compared favorably with our experience with long-term catheters of a similar type placed via a supraumbilical approach into the superior vena cava. We conclude that the infraumbilical route for long-term central venous access is safe and technically easy and should be strongly considered in patients in whom venous access via the supraumbilical approach will be technically difficult or have a high likelihood of failure.