Efficacy of catheter cleaning methods using intravenous indwelling catheter, 10% silver nitrate solution and a monofilament nylon thread for deeply progressed superficial driveline infections: case series

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  Figure 1. Management concepts and schema of the catheter method via the DLES. A deeply progressed superficial DLI is defined as an infection that has extended from the superficial region of the exit site to the deeper portion but has not reached the pump pocket. An intravenous indwelling catheter can flush the driveline tunnel space from the far end of the space. Notably, excessive injection pressure should be avoided when injecting the cleaning solution into the driveline tunnel space to prevent contaminated fluid from entering the deep part of the space. A cotton swab with 10% silver nitrate solution is used to eliminate infected and contaminated tissues or to enlarge the confined space. Nylon threads help with the continuous drainage, utilizing a capillary action despite the narrow space.

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  Figure 2. Evaluation of the depth of DLI. (a) Gallium-67 single-photon emission computed tomography (67Ga SPECT) shows the extent of high signalization from the DLES. (b,c) Body surface echography findings show hypoechoic area around the driveline, suggesting effusion of poorly organized inflammatory fluid from the DLES. (d–f) Cleaning of the driveline tunnel using an intravenous indwelling catheter. The catheter is about 5-cm long; it can be cleaned if the length of the infective driveline tunnel is within reach of the cotton swab and intravenous catheter from DLES. (g, h) The intravenous indwelling catheter may be also useful when the nylon threads are inserted into the driveline tunnel space. A catheter and nylon threads are inserted in the driveline tunnel space. Then, the catheter is removed while leaving the nylon threads. SPECT: single-photon emission computed tomography.

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  Figure 3. The clinical course of development of the DLI in Case 1. (a) There was some distance between the DLES and the spot with redness and induration. (b) 67Ga SPECT shows high signalization within reach of the cotton swab and intravenous catheter from DLES. (c) The spot with redness and induration healed after treatment with this catheter method.

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  Figure 4. The clinical course of recurrence of the DLI in Case 2. (a) The DLES had erythema and induration. (b) 67Ga SPECT showed an inflammation area localized to 5 cm around the DLES. (c) Purulent discharge was decreased, and the space around the driveline was reduced.

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  Figure 5. The clinical course of development of the DLI in Case 3. (a) Skin induration and tenderness along the driveline tunnel and bleeding and purulent discharge from the driveline tunnel space were found. (b) 67Ga SPECT suggested a high signal up to 5 cm inside the DLES. (c) The exuded solution became clear, and the amount gradually decreased. The patient’s DLI gradually improved.