Читать книгу Emergency Management of the Hi-Tech Patient in Acute and Critical Care - Группа авторов - Страница 78

The catheter tip of most CVCs terminates at the junction of the superior vena cava (SVC) and the right atrium (RA). The venous path each catheter takes to get to the central circulation depends on the type of device. Tunneled, externalized catheters are usually inserted in the subclavian, external jugular, or cephalic vein, while implanted devices are usually inserted in the subclavian or internal jugular vein (Figure 5.1. CHOP Family Information Line Drawing w/anatomy). Externalized catheters are tunneled from the point of venous access to an exit point in the patient's chest, where a Dacron cuff stimulates tissue adherence, thereby discouraging both catheter migration and microbial infiltration (Figure 5.2). Fully implanted catheters (ports) are tunneled from their point of venous access to a subcutaneous pocket in the chest wall, where they terminate in a reservoir that is sutured in place for stability. The reservoir of the port communicates with the catheter portion of the device and is topped by a silicone self‐sealing septum that is accessed through the skin with a noncoring needle (Figure 5.3). PICC lines, which have no tunneled component, are generally inserted in the upper arm through the basilic, brachial, or cephalic vein from which they are advanced into the SVC.