Figure 18-8 Cuffed, tunneled catheter. (Source: Adapted from The Royal Marsden NHS Foundation Trust. Central Venous Access Devices. London: Lundie Brothers Ltd., 2004.)

Figure 18-9 Implantable port placement.

ingrowth from the cuff. Other advantages of a cuffed, tunneled catheter include minimal interference with patient activity, low incidence of unintended dis-lodgment, and potential repair via a kit. Disadvantages include the need for regular maintenance and the fact that some patients find it cosmetically unacceptable.

Implantable ports (Port-A-Cath, Infuse-A-Port) are also tunneled, but they have a subcutaneous portal with a self-sealing septum that can be accessed by needle puncture through intact skin (Fig. 18-10). They require less manipulation and have lower complication rates than other CVCs. Ports are cosmetically superior to external tunneled catheters, require less maintenance, and afford patients greater freedom of movement. They are often used when prolonged venous access is necessary, for example, in intensive chemotherapy regimens. Disadvantages of implantable ports include the need for a specific small gauge access needle (Huber) and special training for users of the device. The Huber needle limits fluid infusion rates and increases the potential for subcutaneous extravasation.

Both cuffed CVCs and implantable ports can remain in place indefinitely until they are no longer needed, have thrombosed, become infected, or fail to function.

Peripherally inserted central catheters (PICC, Fig. 18-11) are noncuffed, non-tunneled catheters and can last for months. They can be single or double lumen and can have a Groshong valve. PICC lines are generally placed in the basilic or cephalic veins proximal to the antecubital fossa. PICC line advantages include bedside placement/removal, ease of use, and simple maintenance.

Extension set Needle

Extension set Needle body

Silicone membrane

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