Securing central venous catheters: PT fixation technique.

To the Editor,

Central vein catheters (CVCs) through major neck vein are always needed in major surgeries for various reasons, and securing them properly after placement for a short term is equally important. Few methods have been described previously, such as (a) the skin fold method,[1] (b) the finger trap method,[2] (c) Wings fixation,[3] and (d) the shoelace method.[3] When the number of lumens is more in a catheter, that is, three or four, the girth of the catheter increases and the outer part of the multi-lumen catheter gains more weight and there are chances of it slipping out even if a securing device is used on the catheter. Second, when the CVCs are sewed to the neck at various places and the whole dressing is placed on the neck, the neck being a sensitive area of the human body gives a troublesome itchy continuous sensation to the patient and they keep their neck still making it stiff and painful. This happens so long as the catheter remains in situ. When the catheter is secured with many sutures, at four to five places, removing it by nurses in the intensive care unit is also sometimes a difficult task and if the catheter stays for a long time, then the number of scar marks increase.

The new PT fixation and dressing technique devised and created by Prof. Prabhat Tewari of Sanjay Gandhi Post-graduate Institute of Medical Sciences (SGPGIMS) addresses to all the above shortcomings by fixing three or four lumen CVCs in a unique fashion. The neck is properly painted and draped with full aseptic precautions and procedures. Here, once the exact length of the CVC is placed in the vein so that the tip is well above the superior vena cava, right atrium junction, and the securing device is placed on it, only two sutures (single Braided silk, length 90 cm, divided into two parts) are placed parallel to the catheter ahead of the securing device on either side [Figure 1 panel A]. The first knot is taken on the skin with a silk thread, and then, further three to four knots are taken as air knots so as to reach on one side of the securing device. Silk is then passed through the side hole, and then, two knots are placed to secure the device [Figure 1, panel B]. The same procedure is repeated on the other side, and once the securing device is knotted on these air knots, long threads are wound around the catheter from both sides so as to reach the multi-lumen catheter hub with fixation holes [Figure 2]. The long threads from either side are passed through the side holes of the hub of the catheter and tied together by two to three surgical knots. Then, a transparent dressing is taken, and the whole catheter is sandwiched between two halves of this dressing [Figure 3, upper panel and lower panel]. Thus, only two suture points are there on the skin, the catheter cannot slip out of the securing device, the air knots keep the thick plastic parts away from the neck of the patient, and the whole catheter assembly falls away from the neck when the patient sits up. It is totally concealed inside the transparent dressing; thus, it remains sterile and water- and moisture-free. Patients tolerate this better, and nurses are happy as they have to take out only two single sutures to remove the catheter on discharge of the patient. The problems of kinking of the catheter, displacement or pulling out of the CVC, and infection around the catheter have been very rare, and it can be kept for 3–4 days. If it is kept for a longer time, then the transparent dressing is peeled and a new similar dressing is placed after drying the skin around. It is a cost-effective proposition as a single surgical suture is used and a single transparent dressing is used.

Figure 1

(a) Sutures are placed parallel to the CVC on either side, and two surgical knots are taken on the skin and then three to four air knots are taken. (b) The fixation device is sutured on these knots away from the skin. (c and d) Both sutures are entwined around the CVC and brought up on either side of the catheter wings and threaded through the holes and secured

Figure 2

(a) CVC fixed securely. (b-d) Application of the transparent dressing (10 by 12 cm) split in half and applied from both sides sandwiching the CVC in between

Figure 3

After fixing the CVC, the catheter is sandwiched between two parts of the transparent dressing so that it falls away from the patient but remains securely tied to the neck

This technique is being used for the last 13 years to fix multi-lumen CVCs in cardiac surgical patients at SGPGIMS Lucknow, India, in more than 10,000 patients with good outcomes. We have tried to bring this PT fixation technique to the fore for everyone to use and take benefit out of it.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.