II. Indications

  1. Bleeding at site of tunneled catheter (e.g. central venous line, Dialysis Catheter)

III. Complications

  1. Central Line infection
  2. Catheter puncture
  3. Vessel ligation
  4. Failure to control bleeding
  5. Localized hematoma

IV. Technique

  1. Images
    1. SurgeryPurseStitch.jpg
  2. Prepare the site with antiseptic (e.g. Hibiclens)
  3. Inject Anesthetic with Epinephrine into the region around the catheter entry site
  4. Use 3-0 Nylon Suture
  5. Start alongside catheter entry, beside the skin opening of the buried catheter
    1. Place the Suture parallel to the catheter, from distal (buried catheter) to proximal (external catheter)
  6. Reenter the skin, and place a Suture under the external catheter, exiting on its opposite side
  7. Reenter the skin again and exit across from the initial entry, alongside the start of the buried catheter
  8. Tie the Suture taught over the skin covering the buried catheter start
    1. Toggle device (twisted to tighten) may also be used to apply greater site compression
  9. Clean and bandage the site with transparent dressing

V. Resources

  1. Purse-String Technique (Figure B)
    1. https://thejns.org/pediatrics/view/journals/j-neurosurg-pediatr/10/4/peds1280f3.jpg

VI. References

  1. Warrington (2021) Crit Dec Emerg Med 35(10): 29
  2. Kerr (2008) J Vasc Interv Radiol 19(8):1176-9 +PMID: 18656010. [PubMed]

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