PLACEMENT AND MANAGEMENT OF LONG-TERM CENTRAL VENOUS ACCESS CATHETERSAND PORTS

Recent developments in long-term central venous access devices, access techniques, and the management of complications are described. Factor s used in selecting a device include the intensity and frequency of th erapy and the preferences of the patient. Implantable ports and extern al catheters are available with valved (Groshong) and nonvalved cathet ers and with single or multiple lumens. Single- or dual-lumen, periphe rally inserted central catheters and ports provide a smaller and less invasive alternative to central access. Sonographic guidance during ce ntral catheterization allows detection of venous abnormalities, increa ses the success rate, and decreases the number of complications. When occlusion of the jugular veins, subclavian veins, or superior vena cav a prevents routine access, alternatives include translumbar or transhe patic cannulation of the inferior vena cava. Common complications of l ong-term access are catheter and venous thrombosis and catheter infect ion. Catheter thrombosis is treated by fibrinolysis. Daily administrat ion of 1 mg of warfarin reduces the risk of thrombosis. An infected ca theter can be diagnosed without catheter removal by comparison of quan titative blood cultures from the catheter and peripheral vein. Early r ecognition of catheter-related infection may save the catheter. Remova l of an infected catheter depends on the nature of the offending agent , severity of infection, success of treatment, and degree of difficult y in obtaining alternative access.