What is placement of a subclavian venous infusion catheter with an implantable target?

Placement of a subclavian venous infusion catheter with an implantable target is a procedure in which the doctor places one end of a catheter (tube) into a large vein in the upper part of your chest and leads the other end under the skin away from the vein to another site just under the skin. The end of the catheter has a reservoir, or target, into which drugs can be injected. The reservoir is a storage space for fluids.

When is it used?

This procedure allows you to take drugs without needing a needle in your vein through which drugs would be given.

Examples of alternatives are:

• to have the drugs put into one or more of the smaller veins that lie close to the surface of the skin

• to have a subclavian venous infusion catheter with the intravenous line coming out of the skin (an external lumen) (This option would lead to a greater risk of infection.)

• to choose not to have this procedure.

You should ask your doctor about these choices.

How do I prepare for the procedure?

Plan for your care and recovery after the operation, especially if you are to have general anesthesia.

Follow instructions provided by your doctor. If you are to have general anesthesia, eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

No particular preparation is needed for local anesthesia.

What happens during the procedure?

You will receive a local or a general anesthetic. This drug should keep you from feeling pain.

The doctor will make a small cut in your upper chest and place one end of the catheter into a large vein under your collarbone. The doctor will keep the other end of the catheter directly under the skin and lead it away from the puncture site. The catheter will be fitted with a target that can hold drugs. The doctor will sew the cut closed.

What happens after the procedure?

You will be observed for a few hours while recovering from the anesthetic. Then you may go home. You should avoid strenuous activity for a day. You will have a dressing over the cut for a few days.

You will need to have the catheter for as long as you need injections of medication.

Ask what other steps you should take and when you should come back for a checkup.

What are the benefits of this procedure?

You will avoid the pain and discomfort of having to have medicine injected into a vein.

You can avoid the damage to your veins caused by the needles and strong medications.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your doctor.

• The local anesthesia may not numb the area quite enough and you may feel some minor discomfort. Also, in rare cases, you may have an allergic reaction to the drug used in this type of anesthesia. Local anesthesia is considered safer than general anesthesia.

• By inserting the catheter into a vein in your chest, the doctor may tear the lung cavity or the lung. This could cause the lung to collapse, which would require another procedure under a local anesthetic to reexpand the lung.

• As long as the catheter is in place, it may become infected. In that case, the catheter and the target would have to be removed.

• A clot may form around the tip of the catheter in the vein and block it.

• Infection or bleeding may develop.

You should ask your doctor how these risks apply to you.

When should I call the doctor?

Call the doctor immediately if:

• You develop a fever.

• You become short of breath.

• You develop a red, swollen, or tender area around the implanted reservoir.

Call the doctor during office hours if:

• You have questions about the procedure or its result.

• You want to make another appointment.