1 / 22

Hicman-Line-Final

Dr Prashant Jain is a young and dynamic pediatric surgeon and pediatric urologist. He has been trained in premier institutes, King Edward Memorial Hospital (KEM), Mumbai and Kalawati Saran childrenu2019s hospital, New Delhi. He has been a meritorious student throughout his medical career and was a gold medalist in his training in pediatric surgery and pediatric urology.

DrPrashantJain
Download Presentation

Hicman-Line-Final

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. TUNNELED CATHETERS Dr Prashant Jain Sr Consultant Ped. Surgery BLK Superspeciality Hospital, New Delhi

  2. What is tunneled catheter?  Processed silicone  A tunneled central line is a catheter (a thin tube) that is placed in a vein for long-term use  It is most commonly placed in the internal jugular or subclavian vein .

  3. T U N N E L

  4. Purpose Long term infusions and chemotherapy for longer than 3 weeks  Chemotherapy and bone marrow transplant (BMT)  Plasmapheresis and leukapheresis  Hemodialysis  Total parenteral nutrition (TPN)

  5. Parts  It has a cuff Antimicrobial cuff Allows tissue and skin to grow around it  Keeps it more stable and infection free CLAMP CUFF CONNECTORS

  6. Types  Hickman catheter  Broviac Catheter  Groshong Catheter

  7. Hickman Catheter • Single, Dual and Triple Lumen • Range from 2.7 FR- 12.5 FR • Repairable • Easy to handle

  8. What is the advantage? Product Tunneled CVC Dwell Time 1-6 months  Secured for long time  No repeated Poking  Reduces the discomfort Non- Tunneled CVC 3-6 weeks

  9. Selection  Purpose  One size does NOT fit all  Number of lumens

  10. Contraindications  Deranged coagulation  Sepsis  Local Infection  Allergy

  11. Preparation  Anesthesia: GA/LA  No antibiotics  Informed consent  Position  Rt IJV is preferred  Sterility is MANDATARY

  12. Equipment C-ARM ULTRASOUND

  13. Catheter Trolley

  14. A V

  15. Chemoport

  16. Retrospective study @BLK Total patients: 126 VAD 14 44 Hickman catheter Male 112 Female Chemoport 82

  17. Indications Benign hematological disorder  Duration of study :37 months  Mean duration of catheter in situ: 116.13 days  Median catheter days:180 days  Minimum age:5months  Maximum age:18 yrs 15 Hematological malignancies 31 80 Solid tumors

  18. Procedure  Right internal jugular vein  101 patients had double lumen catheter  11 patients had single lumen catheter

  19. Ultrasound and Fluoroscopic guidance

  20. Overall complications: 13/126 Intraoperative 2 Hematoma formation 1 Supraventricular Tachycardia 1 Premature removal 11 Accidental removal 1 Transmigration of catheter into right pulmonary artery 1 Catheter misplacement 2 Catheter blockage 1 Fracture of catheter 2 Infection 4

  21. Conclusion  Complication rates are less than/comparable to the studies reported in literature showing rates of premature removal between 10% to 30.2% (Our study:10.3%).  Catheter related infections were common cause of premature removal in our study, which occurred in 3.17 %  USG & flouroscopic guidance reduces: -Primary catheter malposition -Successful insertion at the first attempt -Optimum catheter tip position -Reduces mechanical occlusion  Complications like pneumothorax, accidental arterial perforation ,vascular erosion, catheter compression are markedly reduced due to USG guidance -0%(our study)

More Related