Image Guided Central Venous Line and Port Insertion

Abstract

Image Guided placement of lines and ports by Interventional Radiologist has increased dramatically over last decade and has advantage of precise positioning of the catheter tip and have less chance of complications like pneumothorax and arterial puncture These lines and ports are used for infusion of antibiotics chemotherapeutic drugs and administration of blood products hyperalimentation dialysis and aphaeresis PICC are long intravenous lines inserted under ultrasound guidance in basilic vein or brachial vein The advantage of inserting under image guidance is that PICC can be inserted through mid arm vein and elbow joint is free for movement Some IR is these days placing tunnelled PICC for securing these PICC and to decrease change of infection at exit site The inner end of these PICC is generally at cavoatrial junction Power PICC have recently been approved for use in India and these PICC can be used with pressure injector with flow rate up to ml sec and pressure up to Psi Non tunnelled CVC are indicated for short term use and these CVC are generally inserted into jugular vein Non tunnelled CVC insertion is generally done as bed side procedure and that too in quick time But non tunnelled CVC have high chance of infection and are dislodged easily Tunnelled CVC are inserted under image guidance into large vein jugular vein and then this catheter travel through a subcutaneous tunnel before exiting the skin These catheters have dacron cuff embedded on the shaft and it is believed that these dacron cuff incite a fibrotic reaction that ultimately secures the catheter in place and decrease spread of infection from skin exit site to the circulation Tunnelled Hickman Catheters are generally dual lumen devices and generally used for aphaeresis Tunnelled Hemodialysis catheters are generally Fr dual lumen devices with length varying from cm to cm and these catheters are capable of handling high flow rate to ml min Ports are made of titanium and plastic and this part have two parts a a silicone or polyurethane catheter and this catheter are generally connected to a b reservoir These reservoirs are accessed by special non coring Hubner needle through the skin and a silicon window These Ports are available in single or double lumen configuration and entire port is buried in the subcutaneous tissue of the chest or arm or even the thigh or abdomen Recently Power Port has been approved for use in India and these Power Port are triangular in shape and can be used with Pressure Injector The selection of most appropriate catheter in an individual case is made jointly by the referring physician IR and the patient The choice of which access device to choose is a collaborative process and this decision needs to be made judiciously Care and maintenance of these catheters and ports is important so that this access device can be used for long time