1. BENEFITS OF UNCUFFED, TUNNELED CENTRAL VENOUS CATHETERS IN NEONATAL CARDIAC SURGERY
George M. Foulard, William I. Douglas MD
Department of Pediatric Surgery, Division of Pediatric Cardiovascular Surgery; University of Texas Medical School at Houston; Houston, Texas
BACKGROUND
TECHNIQUE
RESULTS
Central venous access is necessary for neonatal cardiac surgery and post-operative care.
Standard, percutaneous catheters have a limited duration of use without risking associated blood stream infections.
This study addresses the benefits of routinely using uncuffed, tunneled CVC’s for neonates undergoing cardiac surgery to provide durable vascular access.   
32 neonates received uncuffed, tunneled CVC’s.
The average weight was 3.3 kg (Range 2.1 kg – 5.0 kg).
27 patients received double lumen catheters.
12 patients had single ventricle physiology.
16 patients underwent cardiopulmonary bypass.
The CVC’s remained in place for an average of 22.2 days (median 13 days, range 2 days – 83 days).
6 of the CVC’s were in place for greater than 30 days.
14 patients received a total of 47 blood cultures post-operatively.
All blood cultures were negative.
Incision Size
Vein Dissected and Ligated Distally
Guidewire Used to Tunnel the Catheter
METHODS
Neonates who had uncuffed, tunneled CVC’s placed at the time of cardiac surgery from January, 2013 through May, 2014 were evaluated retrospectively.
Patients with delayed sternal closure (principally after the Norwood procedure) were excluded.
CVC’s were primarily placed through the saphenous vein by direct cut-down centimeters below the inguinal crease.
The catheters were tunneled subcutaneously to exit the skin in the mid-thigh.
CVC’s were only removed when no longer utilized clinically; they were not removed earlier as infection prophylaxis.
Catheter Tunneled; Larger than Vein
Vein Pick in Vein (after venotomy)
Catheter Inserted Directly Into Vein
CONCLUSION
Uncuffed, tunneled CVC’s allowed the benefits of durable vascular access without the need for multiple vascular access sites.
No associated blood stream infections were encountered.
Prospective, randomized, and multi-institutional studies would be required to definitively evaluate the benefits of this approach.
Vein Snug Around Catheter
Completed Line Placement
Close-up of Vein Pick