Name: Introduction and Tunneling of Catheter
Uploaded: 2023-03-31T14:00:00
Description: Watch this Scientific Journal Video about Introduction and Tunneling of Catheter at JoVE.com

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

用于猪长期血管通路的 Hickman 导管

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.

作者聚焦：Hickman 导管在临床前猪模型中用于长期血管通路  

Hickman 导管在临床前猪模型中用于长期血管通路

This protocol describes a reliable and reproducible technique for the insertion and maintenance of a tunnel Hickman catheter for long-term vascular access in a large animal model. The approach allows for convenient daily sampling of whole blood from awake animals and intravenous administration of medication and fluids. Some of the main challenges to the long-term central venous lines in large animals are infection and damages.As large animals are occasionally able to gain access to the lines and cause mechanical trauma. To mitigate these challenges, our group has invented our special pouches that protects the line while still allowing easy access to the same catheter. Central venous catheters are invaluable devices in large animal research as they facilitate a wide range of medical applications, but there is no consensus on the best practices for their insertion and maintenance.In response, we have proposed a protocol that comprehensively describes an approach for proper placement of a tunneled Hickman catheter in pigs that minimizes catheter-related complications and morbidity. The use of our approach in over 100 pigs has resulted in long-term patency and minimal complication rates. This protocol offers a method to optimize the lifespan of the Hickman catheter, and guidance for approaching issues during its use.

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

Introduction and Tunneling of Catheter  

导管的引入和隧道

对于导管的隧道，取下湿纱布并重新识别孤立的 IJV 段，然后选择一个目标进入部位进行导管引入，其深度与 IJV 相同，比胸锁乳突肌更深，以及在两个涂层和编织的不可吸收缝合系带之间。在背侧手术野中用惯用手握住希克曼导管引入器，并将导管的剩余长度悬挂在无菌野上方的空气中。非惯用手应位于腹侧手术区域。用惯用手将导引器插入出口穿刺部位，将装置的尖端指向腹野中的非惯用手。向浅部和内侧推动导引器的尖端，使导管穿过脂肪组织，用非惯用手感觉尖端的出现。一旦尖端出现在目标进入部位，将导引器和导管拉过皮下隧道，直到主线的袖带刚好位于背野皮肤表面下方。

Research

JoVE Journal

Medicine

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 ...