The video provides a detailed procedural guide for tunneling a catheter into the internal jugular vein (IJV). It describes the steps for choosing an entry site, using a Hickman catheter introducer, and ensures precise catheter placement beneath the skin. Proper hand positioning and technique are emphasized throughout the process.

introduction and tunneling of catheter

Catéter Hickman para acceso vascular a largo plazo en cerdos

The indispensable role of central venous catheters (CVCs) in patient care is owed to their convenience, favorable safety profile, and versatility1. Functions of a CVC include reliable access for total parenteral nutrition, hematopoietic stem cell transplantation, plasmapheresis/apheresis, and efficient fluid, blood, or co-drug administration2. In veterinary medicine, CVCs also minimize animal discomfort via the rapid dilution of irritant drugs and blood sampling without repeated venipuncture3. Despite their broad applications, the use of CVCs in large animal research still presents several considerable challenges4.
Percutaneous CVC placement via a guidewire or introducer catheter can be difficult for non-veterinary researchers, particularly in animals with deep venous structures5. An improper CVC installation technique may result in inadvertent placement into nearby structures, necessitating ultrasound-guided placement or a postprocedure radiography of the positioning6. However, compared to human operating rooms, ultrasounds are not readily available in many large animal research laboratories. Further, long-term use of indwelling catheters can result in line kinking, puncture, infection, or extrication by animals, with the possible disruption of timely treatment, clinical monitoring, and research outcomes4,7. Replacement of the CVC requires additional resources, including material procurement, surgical scheduling, fasting time, and radiographic access. CVC-related complications can therefore create significant technical and financial barriers or a disruption to productive translational research, particularly in swine. Contamination by food or feces, scratching against cage walls, and kicking sites of irritation may compromise a CVC, and the risk of CVC-related complications is amplified by long-term use. Thus, safe and uncomplicated maintenance of a CVC in swine requires careful consideration of CVC choice, placement, securement, protection, sanitation, and surveillance.
The Hickman catheter (HC) used in this protocol is a tunneled CVC with a polyester cuff and one to three lumens, that is commonly used for long-term intravenous access in humans and animals1,4,8,9. The tunneled catheter approach has been associated with lower complication rates and maintenance costs relative to non-tunneled variations10,11,12. The cuff reduces HC extrication by incorporating into the subcutaneous tissues surrounding the skin exit site. The multi-lumen design also enables the separation of medication administration and blood draws, thereby minimizing blood sample contamination and inaccuracy. Despite this, HC use is not without challenges, the most common of which include fracture, migration, occlusion, and infection13,14,15,16. Proper installation and maintenance of a HC are therefore indispensable skills when used in translational research. However, the current literature offers little guidance for best-practices for HC use in swine during long-term trials5,6,17.
The purpose of this study is to outline an optimized approach for HC insertion into the internal jugular vein (IJV), skin securement, and durable protection that minimizes long-term catheter-related complications and discomfort in swine. A discussion of the important considerations for HC use, potential challenges that may be encountered, and modifications that may improve the quality of this approach is included.

Autor destacado: Uso del catéter Hickman para el acceso vascular a largo plazo en un modelo porcino preclínico  

Uso del catéter Hickman para el acceso vascular a largo plazo en un modelo porcino preclínico

Watch this Scientific Journal Video about Introduction and Tunneling of Catheter at JoVE.com

Introduction and Tunneling of Catheter  

Introducción y tunelización del catéter

Para la tunelización del catéter, retire la gasa húmeda y vuelva a identificar el segmento aislado del IJV, luego elija un sitio de entrada objetivo para la introducción del catéter por vía subcutánea a la misma profundidad que el IJV, más profundo que el esternocleidomastoideo y entre las dos ataduras de sutura no absorbibles recubiertas y trenzadas. Sostenga el introductor del catéter Hickman en la mano dominante en el campo quirúrgico dorsal y suspenda la longitud restante del catéter en el aire por encima del campo estéril. La mano no dominante debe estar en el campo quirúrgico ventral.Inserte el introductor en el sitio de punción de salida con la mano dominante, apuntando la punta del dispositivo hacia la mano no dominante en el campo ventral. Empuje la punta del introductor superficial y medialmente para tunelizar el catéter a través del tejido adiposo, sintiendo la salida de la punta con una mano no dominante. Una vez que la punta emerge en el sitio de entrada objetivo, tire del introductor y el catéter a través del túnel subcutáneo hasta que el manguito de la vía principal esté justo debajo de la superficie de la piel del campo dorsal.

Research

JoVE Journal

Medicine

Introduction and Tunneling of Catheter

282 vistas. Para la tunelización del catéter, retire la gasa húmeda y vuelva a identificar el segmento aislado del IJV, luego elija un sitio de entrada objetivo para la introducción del catéter por vía subcutánea a la misma profundidad que el IJV, más profundo que el esternocleidomastoideo y entre las dos ataduras de sutura no absorbibles recubiertas y trenzadas. Sostenga el introductor del catéter Hickman en la mano dominante en el campo quirúrgico dorsal y suspenda la longitud restante del ca...

Video: Introduction and Tunneling of Catheter  

Hickman Catheter Use for Long-Term Vascular Access in a Preclinical Swine Model

Central venous catheters (CVCs) are invaluable devices in large animal research as they facilitate a wide range of medical applications, including blood monitoring and reliable intravenous fluid and drug administration. Specifically, the tunneled multi-lumen Hickman catheter (HC) is commonly used in swine models due to its lower extrication and complication rates. Despite fewer complications relative to other CVCs, HC-related morbidity presents a significant challenge, as it can significantly delay or otherwise negatively impact ongoing studies. The proper insertion and maintenance of HCs is paramount in preventing these complications, but there is no consensus on best practices. The purpose of this protocol is to comprehensively describe an approach for the insertion and maintenance of a tunneled HC in swine that mitigates HC-related complications and morbidity. The use of these techniques in &gt;100 swine has resulted in complication-free patent lines up to 8 months and no catheter-related mortality or infection of the ventral surgical site. This protocol offers a method to optimize the lifespan of the HC and guidance for approaching issues during use.

A reliable and reproducible approach for the insertion and maintenance of a tunneled Hickman catheter for long-term vascular access in swine is described. Placement of a central venous catheter allows for convenient daily sampling of whole blood from awake animals and intravenous administration of medication and fluids.

Central venous catheters (CVCs) are invaluable devices in large animal research as they facilitate a wide range of medical applications, including blood ...