Clavicular hook: Cuffed haemodialysis catheter insertion using a paramedian tunnel in patients with recurrent tip...

Area of Science:

• Vascular Surgery
• Nephrology
• Medical Devices

Background:

• Tunnelled, cuffed central venous catheters are essential for haemodialysis.
• Internal jugular vein catheters are typically tunnelled subcutaneously to the anterolateral chest wall.
• Lateral subcutaneous tracts increase catheter migration risk, especially in obese patients or those with large breasts, leading to catheter failure.

Purpose of the Study:

• To describe a novel surgical technique for central venous catheter placement.
• To address recurrent catheter migration in patients undergoing haemodialysis.

Main Methods:

• Two cases of internal jugular vein catheter placement are presented.
• A paramedian subcutaneous tunnel was fashioned instead of the traditional lateral tunnel.
• The technique aimed to mitigate risks associated with obesity or large breast tissue.

Main Results:

• The paramedian tunnel technique was successfully implemented in both cases.
• Recurrent catheter migration was prevented post-operatively.
• This approach offers a viable alternative for managing challenging catheter placements.

Conclusions:

• A paramedian tunnel for internal jugular vein haemodialysis catheters is a promising modification.
• This technique may reduce catheter migration in patients with specific anatomical challenges.
• Further studies are warranted to evaluate the long-term efficacy and broader applicability of this method.