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What is a Trifusion-Triple lumen catheter?

A trifusion triple lumen catheter is a central venous catheter made of polyurethane adapted from a Hickman catheter design. The catheter is a tunneled central venous catheter much like the Hickman catheter and is used for and considered a long-term catheter.  The main difference between a trifusion catheter and a Hickman or broviac catheter or other similar catheters is the three lumen design of the catheter.  This allows for the catheter to be used for various reasons simultaneously ie. for collecting blood samples and administering drugs. The catheter enters the vein near the base of the neck (Most commonly the internal jugular vein) where it travels through the central veins with one end of the catheter is placed in a large vessel near your heart (Superior vena cava/right atrial junction) and the other end tunneled under the sin exiting below the collar bone on the chest.

The catheter comes with a tissue in growth cuff that keep the catheter fixed in a subcutaneous tunnel. It has three large lumens that are of equal size and appropriate for apheresis. The proximal lumen is used for blood products and the distal lumen for blood return during the procedure of apheresis.

Indications

Trifusion triple lumen central venous catheter can be used for both long-term and short-term venous access. It is used in the following situations;

  • Obtaining blood samples frequently
  • Intravenous infusion therapy
  • Administration of fluids, drugs and blood products.
  • Parenteral nutrition
  • Apheresis

Contraindications

  • The catheter should not be used in the presence of a catheter related infection
  • Allergy to materials of which the catheter is made
  • Infection at the catheter entry site

Placement and Removal of Trifusion Catheter

The catheter can be placed in the chest or the groin although the chest is preferred because of decreased infection risk as compared with the groin.  The right side is preferred to the left because of the more direct course of the veins.  Most commonly the catheter is placed into the internal jugular vein on the right just above the clavicle where it passes through the subclavian/brachiocephalic vein to enter the superior vena cava with the tip of the catheter opening at the superior vena cava (SVC) right above the right atrium of heart. The catheter can also be inserted into directly into axillary-subclavian vein percutaneously as opposed to the more common jugular vein access. If the catheter enters medially, there is a chance of catheter compression between first rib and clavicle, this is referred to as pinch off syndrome.

Once the catheter enters the vein above the clavicle it is then tunneled under the skin towards the exit site on the chest. The cuff that is attached to catheter is positioned within the tunneled portion under the skin and is responsible for keeping the catheter in place.  The catheter is initially sutured in place to allow the cuff to have tissue ingrowth.

Since the retention cuff encourages tissue growth, the catheter needs to be removed by a procedure. like all central vein catheters pts should lay flat or with their head below the level of their heart.  patients should never be sitting upright in order to mitigate the risk of air embolism during catheter removal. Local numbing medication is injected at the catheter exit site around the cuff and the cuff is then dissected away from the ingrown tissue. Once the cuff is freed, the catheter can be removed easily by a gentle pull.

Complications with Trifusion catheters

Just like all the other central venous catheters, trifusion have a few complications which are uncommon and have become even less common with the adoption of ultrasound imaging and fluoroscopy used during the placement of the catheter. Here are a few of the complications;

  • Air embolism
  • Bleeding
  • Catheter related infection
  • Cardiac arrhythmias
  • Catheter or cuff erosion through skin
  • Thrombosis
  • Pneumothorax and haemothorax
  • Catheter related sepsis
  • Endocarditis

Trifusion Catheter Care

Catheter care is an important component of aftercare. All central venous catheters have the potential of causing serious infections and complications that could lead to patient morbidity and mortality. Proper hygiene while inserting, examining, changing dressing and removing catheter is of immense importance.

In case of any redness, swelling, bruising and extrusion at the catheter entry site on the chest or at the venotomy on the neck all fluid infusions or blood draws should be discontinued and appropriate medical therapy started. Make sure that dressing remains dry and is firmly secured to the area so that catheter remains in position and is protected from infection.

Catheter should be regularly monitored for any kind of damage or pulling, since this could be a potential source of mispositioning of the catheter or fragmentation and even more concerning complications.

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