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Cannulation of inferior vena cava for long term central venous access
S Curtas1, M Bonaventura, M M Meguid
1Department of Surgery, University Hospital, SUNY Health Science Center, Syracuse 13210.
Insights
Inferior vena cava (IVC) catheterization via lower extremity veins offers a viable long-term central venous access solution when superior vena cava (SVC) access is not possible. This method demonstrated a low complication rate, making it a safe option for patients requiring extended venous access.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Critical Care Medicine
Background:
- Long-term central venous access is crucial for various medical treatments.
- Superior vena cava (SVC) access is often precluded in certain patient populations.
- Alternative venous access sites are necessary when SVC access is contraindicated.
Purpose of the Study:
- To evaluate the feasibility and safety of placing Silastic catheters into the inferior vena cava (IVC) via lower extremity veins.
- To assess the efficacy of IVC catheterization for long-term venous access in patients with contraindications to SVC access.
Main Methods:
- Nineteen patients underwent Silastic catheter placement into the IVC through lower extremity veins.
- Strict aseptic techniques and specific operative precautions were employed.
- Catheter dwell time, usage for medication/nutrition/blood administration, and complication rates were meticulously recorded.
Main Results:
- Catheters remained in place for a total of 2,215 days (mean 111 days per catheter).
- Catheters facilitated administration of medications, blood products, chemotherapy, and parenteral nutrition, as well as blood sampling.
- Four complications occurred: catheter sepsis (1), subcutaneous tract infection (1), and IVC thrombosis (2). No deaths were reported.
Conclusions:
- Long-term access to the IVC via lower extremity veins is a feasible and safe alternative when SVC access is precluded.
- This technique provides essential central access for patients with complex medical conditions.
- The low complication rate supports the use of IVC catheterization in selected patients requiring extended venous access.
Abstract:
Nineteen patients had a Silastic (silicone rubber) catheter placed into the inferior vena cava (IVC) by way of a vein of a lower extremity. All patients needed long term venous access but had conditions precluding access to the superior vena cava (SVC) or access sites of the upper torso. Precautions regarding operative technique for the placement of the catheter include incisions through healthy skin, maintenance of aseptic technique at the site of access, an atraumatic subcutaneous tunnel at least 25 centimeters in length and a long acting local analgesic effect. Catheters were in situ for a total of 2,215 days (a mean of 111 days per catheter). Catheters were also used to administer intravenously medications, blood and blood products, chemotherapeutic agents, parenteral nutrition and for sampling of blood. Four complications occurred: one instance each of catheter sepsis and infection of the subcutaneous tract and two of thromboses of the IVC. No deaths occurred. The complication rate was 0.18 per cent per catheter-day. Long term access to the IVC is feasible without undue concern in conditions in which access to the SVC is precluded but long term central access is essential.