CATHETERS AND PORTS
Catheters, in their simplest form, are merely tubes inserted into a body cavity for the purpose of fluid removal, injection, or both. Catheters are placed when there is a clinical need for repeated sampling, injection, or vascular access, usually on a temporary basis. In kidney failure, catheters allow emergent blood access for hemodialysis and hemofiltration . Catheters are often placed when frequent, repeated doses of medication are to be injected, blood samples are to be taken, and for monitoring of hemodynamic performance in critically ill patients . The anatomic location for temporary central venous catheter (CVC) insertion and placement can be dictated by certain patient or disease restrictions, but the most common sites are the internal jugular vein (neck), the femoral vein (groin), and the subclavian position (upper chest). The internal jugular approach is the first choice for placement of a hemodialysis CVC, while femoral placement is favored when rapid insertion is essential Subclavian vein access has fallen from favor due to a higher incidence of thrombosis and stenosis associated with this site.
PROPERTIES
Ease of handling Easy insertion and use Minimal thrombotic and other biocompatibility-related complications Structural and operational reliability Optimization for application-specific performance issues
DEVICE SELECTION
Placement site Duration of implantation Composition of fluids infused
TYPES
Vascular catheters can be divided into two general groups: short-term, temporary catheters that are placed percutaneously; and long-term, indwelling vascular catheters that usually require a surgical insertion. Temporary catheters include short peripheral venous and arterial catheters, nontunneled central venous and arterial catheters, and peripherally inserted central catheters. Tunneled central venous catheters and totally implantable intravascular devices (i.e., ports) are used for therapies requiring long-term vascular access . The term tunneled refers to the placement of the catheter exit site at a location away from the area where the vasculature is penetrated, with the portion of the catheter between these two locations lying in a subcutaneous position. Peripheral venous catheters are the most common devices used for intravascular access, while the nontunneled central venous catheter is the most common central catheter. Subcutaneous ported catheters are the preffered long term catheters.
MATERIALS USED
Short-term use catheters possess a high stiffness and are fabricated from polytetrafluoroethylene, polyethylene, polyvinyl chloride, and polyurethane, although the use of polyethylene and polyvinyl chloride is dropping due to concerns over bacterial adherence in vitro Medium-term (8 to 30 days) catheters are primarily contructed of polyurethane, while catheters implanted for longer periods of time are usually based on polysiloxane, although polyurethane can be used
COATINGS
Catheters have been permeated, coated, or surfacemodified with a variety of compounds in an effort to minimize thrombosis, infection, and friction. Some of the more common strategies for imparting microbial resistance include saturating the catheter material with silver sulfadiazine and chlorhexidine , coating the surface with antibiotics , or bonding heparin to the exterior of the catheter Results with antibacterial and antiseptic coatings have been mixed, but arecent meta-analysis involving several randomized controlled trials has shown a significant reduction in hospital-acquired infections when catheters modified for bacterial resistance are used.
PORTS
A port is similar to a tunneled catheter but is left entirely under the skin. Medicines are injected through the skin into the catheter. Some implanted ports contain a small reservoir that can be refilled in the same way. After being filled, the reservoir slowly releases the medicine into the bloodstream. An implanted port is less obvious than a tunneled catheter and requires very little daily care. It has less impact on a person's activities than a PICC line or a tunneled catheter. Surgically implanted infusion ports are placed below the clavicle (infraclavicular fossa), with the catheter threaded into the right atrium through large vein. Once implanted, the port is accessed via non-coring "Huber" needles inserted through the skin. Ports are typically used on patients requiring only occasional venous access over a long duration course of therapy. Since the port must be accessed using a needle, if venous access is required on a frequent basis a catheter having external access is more commonly used.
