Conversion from temporary to tunnelled central venous catheter

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“We propose a conversion technique without peel-away sheath: a guide wire is advanced through the existing temporary CVC; then, a subcutaneous tunnel is created from the exit to the venotomy site” Limonite et al (2015).

Reference:

Lomonte, C., Libutti, P., Casucci, F., Lisi, P. and Basile, C. (2015) Efficacy and Safety of a New Technique of Conversion from Temporary to Tunneled Central Venous Catheters. Seminars in Dialysis. January 11th. [epub ahead of print].

Abstract:

The usually applied conversion technique from temporary to tunneled central venous catheters (CVCs) using the same venous insertion site requires a peel-away sheath. We propose a conversion technique without peel-away sheath: a guide wire is advanced through the existing temporary CVC; then, a subcutaneous tunnel is created from the exit to the venotomy site. After removing the temporary CVC, the tunneled one is advanced along the guide wire. The study group included all patients requiring a catheter conversion from January 2012 to June 2014; the control group included incident patients who had received de novo placement of tunneled CVCs from January 2010 to December 2011. The main outcome measures were technical success and immediate complications. Seventy-two tunneled catheters (40 with our conversion technique and 32 with the traditional one) were placed in 72 patients. The technical success was 95% in the study group and 75% in the controls (p = 0.019). The immediate complications were one bleeding in the study group (2.5%) and one air embolism, one pneumothorax, and four bleedings (18.7%) in the controls (p = 0.039). Conversion from temporary to tunneled CVC using a guide wire and without a peel-away sheath is an effective and safe procedure.

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