Percutaneous insertion of a cuffed catheter with a long subcutaneous tunnel for intravenous hyperalimentation

An indwelling silicone rubber Dacron-cuffed catheter placed in a long subcutaneous tunnel reduces the incidence of catheter-related sepsis and facilitates dressing changes by the patient, but often necessitates tedious dissection to cannulate a satisfactory tributary of a central vein. Modification of the percutaneous technique for introducing pervenous pacing leads allows placement of central venous feeding catheters without open dissection. A Teflon sheath introducer designed to separate along its longitudinal axis is advanced into a subclavian or femoral vein over a guidewire previously inserted through a percutaneously placed needle. The "peel apart" sheath allows the insertion of the catheter and the subsequent removal of the introducer. C-arm fluoroscopy facilitates and verifies catheter placement. Experience in 31 adult and five pediatric patients has proven this technique to be simple, safe, and expedient within an average operative time of only 20 minutes (12 to 30 min). Successful insertion through the femoral vein as well as insertion under local anesthesia has been achieved without adverse effects. This technique has distinct advantages over previous techniques and lends itself well to the implantation of indwelling central venous catheters on an outpatient or treatment room basis with obviously improved cost-benefit and risk-benefit ratios.