Central Venous Infusion Catheter with External Lumen

What is placement of a central venous infusion catheter with an external lumen?

Placement of a central venous infusion catheter with an external lumen is a procedure for putting a catheter into the subclavian vein. The subclavian vein is a large vein in the upper part of the chest under the collarbone. The catheter is a thin, soft plastic tube. One end of the catheter is passed through the wall of the vein and advanced to a place just above the heart. The outside end of the catheter is used to draw blood or to give you intravenous (IV) medicine.

When is it used?

This procedure allows you to get intravenous (IV) drugs without having a needle repeatedly inserted into your vein.

Examples of alternatives are:

• having the drugs injected into a smaller arm vein that is close to the surface of your skin
• having a catheter with a port under the skin (the port is hollow metal or plastic disc covered by a silicone diaphragm through which drugs can be injected)
• choosing not to have the procedure.

You should ask your healthcare provider about these choices.

How do I prepare for the procedure?

Plan for your care and recovery after the operation, especially if you are to have general anesthesia or sedation. Find someone to drive you home after the surgery.

Follow your healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery. Also, your wounds will heal much better if you do not smoke after the surgery.

If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before your surgery.

Follow any other instructions your provider gives you. If you are to have general anesthesia, eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and on the morning before the procedure. Do not even drink coffee, tea, or water.

What happens during the procedure?

You may be given a local anesthetic with or without a sedative, or you may be given a general anesthetic. A local anesthetic prevents pain by numbing the part of your body where you will have the surgery. A sedative helps you relax. A general anesthetic relaxes your muscles, causes a deep sleep, and keeps you from feeling pain.

Your provider will prepare your upper chest area with a special soap and cover it with sterile drapes. The table you are lying on will be positioned with your feet slightly higher than your head. When the area is numb, a small cut will be made in your upper chest. Your provider will place one end of the catheter into the vein under your collarbone. He or she will tunnel the catheter under the skin for a few inches. The other end of the catheter will stay outside the skin. A suture (stitch) will be placed around the catheter to hold it in place until the wound heals. A small amount of blood thinner will be placed in the catheter to prevent clotting.

What happens after the procedure?

You will have a chest X-ray to check the position of the catheter and to check your lungs.

You will be watched for a few hours, and then you may go home. You should avoid strenuous activity for the rest of the day.

You will need to have the catheter for as long as you need injections of medicine.

Ask what other steps you should take and when you should come back for a checkup.

What are the benefits of this procedure?

You will avoid the pain and discomfort of repeated injections into your veins. The catheter also helps prevent damage to your veins from needles and strong medicines.

What are the risks associated with this procedure?

• A local anesthesia may not numb the area quite enough and you may feel some minor discomfort. Also, in rare cases, you may have an allergic reaction to the drug used in this type of anesthesia.
• When the catheter is inserted into the vein in your chest, the lining of the lung could be punctured. This could cause the lung to collapse. A collapsed lung would require another procedure under local anesthetic to reexpand the lung.
• The longer you have the catheter, the greater the risk of infection. If you get an infection, the catheter will probably have to be removed.
• A clot may form around the tip of the catheter in the vein and block the catheter or block the vein and make your arm swell.

You should ask your healthcare provider how these risks apply to you.

When should I call my healthcare provider?

Call your provider right away if:

• You develop a temperature over 100°F (37.8°C).
• You become short of breath.
• You develop swelling in your arm on the side of your body where the catheter is.

Call your provider during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.