II. Indications
- Bleeding at site of tunneled catheter (e.g. central venous line, Dialysis Catheter)
III. Complications
- Central Line infection
- Catheter puncture
- Vessel ligation
- Failure to control bleeding
- Localized Hematoma
IV. Technique
- Images
- Prepare the site with antiseptic (e.g. Hibiclens)
- Inject Anesthetic with Epinephrine into the region around the catheter entry site
- Use 3-0 Nylon Suture
- Start alongside catheter entry, beside the skin opening of the buried catheter
- Place the Suture parallel to the catheter, from distal (buried catheter) to proximal (external catheter)
- Reenter the skin, and place a Suture under the external catheter, exiting on its opposite side
- Reenter the skin again and exit across from the initial entry, alongside the start of the buried catheter
- Tie the Suture taught over the skin covering the buried catheter start
- Toggle device (twisted to tighten) may also be used to apply greater site compression
- Clean and bandage the site with transparent dressing
V. Resources
- Purse-String Technique (Figure B)
VI. References
- Warrington (2021) Crit Dec Emerg Med 35(10): 29
- Kerr (2008) J Vasc Interv Radiol 19(8):1176-9 +PMID: 18656010. [PubMed]