Abstract

It is estimated that over 500,000 indwelling venous access devices are inserted yearly in the United States.’ Although predominantly inserted in oncology patients, these devices provide long-term access for any patient in need of prolonged infusions. Indwelling venous catheters fall into three broad categories. First, there are silastic catheters. Originally reported by Broviac et al,* they are now known under a variety of names such as Hickman, Leonard, Broviac, and Groshong catheters. They consist of a silastic catheter with one or more lumens that is inserted into the right atrium via a subclavian approach. The proximal end consists of a short segment of silastic tubing that is tunnelled subcutaneously and contains an antimicrobial dacron cuff (Figure 1). The external end separates into individual catheters for each lumen, each containing a reinforced sleeve (clamping area) with clamp and terminating in a disposable luer lock. The second type of indwelling venous access is the subcutaneous port (commonly known as a “Portacath”). Again, these are silastic tubes with one or two lumens inserted into the right atrium via a subclavian approach. The proximal end consists of a short segment that is tunnelled subcutaneously and terminates subcutaneously in a titanium housing with one or two hard rubber domes (Figure 2). A recent variation on this theme is the forearm subcutaneous port. In these patients, a slightly smaller housing is implanted in the forearm and the catheter is placed in a larger vein of the arm. Both subcutaneous ports and Hickman-type catheters are implanted commonly in outpatient surgery units under mild intravenous sedation and local anesthesia. The last group of indwelling venous catheters are the percutaneously inserted central catheters (PICC lines or drum catheters). These are small silastic catheters inserted into the right atrium via a percutaneous puncture of an antecubital vein without any anesthesia or sedation.3 All of the currently used ports and catheters (and all those placed since approximately 1989) are safe for use in computerized axial tomography and magnetic resonance imaging

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