Title:
Use of the organized cuff shaving in the procedures of substitution of septic permanent tunnellizzed central venous catheters (CVC).

Ricciardi B. ;Ricciardi B. ;Ricciardi B. ;Ricciardi B. ;Ricciardi B. ;Ricciardi B. ;Ricciardi B. ;Ricciardi B.^{nonenonenonenone}

1. U.O.C. di Nefrologia e Dialisi Milazzo –Lipari ; 2. Chair of Nefrology Messina University

E-mail address corresponding author:
biagioricciardi@virgilio.it

Background:
The main difficulty, in the techniques of septic permanent C.V.C. substitution, is linked to the risks of contamination of the new prosthesis, during the procedures of explant/implant using the same (sometimes the last) central, jugular or femoral, access way. On the other side, the catheter, in its under-cutaneous course between the Dacron anchorage cuff, and the perivascular sinking site (for example at the right Sedillot triangle), is held by a peculiar cuff-shaving, constituting a very strong neovascular structure isolating the device from the nearer anatomical levels.

Methods:
In case of C.V.C. substitution, according to our tecnique, after incision of cutaneous levels and isolation of the sheathed catheter, is possible with microsurgical technique, cut the sheath, and avoiding whatever lesion of the catheter structure, to use the virtual space between the same sheath and the catheter itself, inserting the guide wire by the right end.This possibility is due to the peculiar catheter compressibility, that easily gives way to the guide wire that slips in the venous vessel without taking wrong ways. Positioned under x-ray the guide wire with its end, in the majority of the cases in the atrium, or eventually in Vena Cava, is possible to extract the extremity of the old catheter, without contamination risks for the complete absence of contacts between the catheter lumen and guide wire, going on after, with the usual implant technique.

Results:
In our casistic in about 100 substitutions of septic Permanent Central Catheter in a period of 5 years in a selected population with 15±5 years of treatment, without any other possibility of vascular access, we obtained 85% of success of the tecnique of implant, ulteriorly confirmed by negative emoculture at one month of distance.

Conclusion:
We could conclude that this peculiar tecnique in the hands of expert operator, can reduce the contamination of new catheters reducing either new implants or pains to the patients.

Subject:
Vascular Access

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