Short communication Technical report: use of ultrasound guidance in the removal of tunnelled venous access catheter cuffs

Venous access catheters are employed for a wide variety of reasons. On removal of the catheter, the subcutaneous catheter cuff can be difficult to extract; retention of the cuff has recognized complica- tions. We describe a simple ultrasound technique that assists in the identification of the cuff within the subcutaneous tissues, simplifying subsequent cuff removal. This may lead to a reduction in associated complications. Venous access catheters are used to deliver long-term intravenous therapy such as haemodialysis, plasmapher- esis, parenteral nutrition and chemotherapy, and enable venous sampling in patients with poor venous access. The majority of tunnelled devices have a short polyester cuff attached to the catheter that encourages fibrosis and therefore anchorage within the subcutaneous tissues. Similar cuffs are employed in some peritoneal dialysis catheters. This cuff can be difficult to localize and extract from the soft tissues when the catheter is removed. In some cases, this may be due to failure to localize the cuff within the soft tissues during manual traction, particularly in large or oedematous patients. We describe a new technique that aids in the identification of the subcutaneous catheter cuff both prior to catheter removal and following cuff retention.