A new method of fixation of silicone rubber catheters for Long-term Hyperalimentation

Abstract

ONG-TERM INTRAVENOUS HYPERALIMENTATION is now an established method of treating patients with life-threatening abnormalities of intestinal function.1*2 Success of the method is predicated to a large degree on the proper placement and maintenance of a central venous catheter. In infants and children, satisfactory long-term central venous cannulation is best achieved by passing a catheter into the superior vena cava through a jugular vein in the neck. In our early experience, the use of polyethylene and polyvinyl plastic intravenous catheters was associated with venous thrombosis, extensive edema of the head and neck, and inflammation along the catheter tract. In the past 4 yr, these complications have been almost completely eliminated by the routine use of less reactive silicone rubber catheters. In contrast to the more rigid plastic tubing, fixation of the softer silicone rubber tubing by usual ligature technique has not been satisfactory. A securely tied encircling holding ligature tends to occlude its lumen and a sIightIy less secure ligature faiIs to prevent accidental dislodgement. Because the frequency of inadvertent catheter dislodgement was unacceptable (25%), a new method of fixation was devised to provide adequate fixation (Fig. 1). After the vein is catheterized, a silicone rubber sleeve to which dacron wings are bonded* is passed around the intravenous catheter at its venous entry site. The dacron wings are sutured to the soft tissues of the neck and the sleeve is glued to the catheter with silicone cement.t The sleeve is buried in the neck beneath the subcutaneous tissues. To remove the sleeve and catheter when intravenous alimentation is no longer required, the small neck incision is opened at the bedside after infiltrating a local anesthetic. The dacron wings are cut away from the tissues to which they have become fixed. The intravenous catheter is divided above the sleeve and the distal catheter is withdrawn