Silicone tunneled catheters may develop ballooning or bulging during infusion and flushing which indicates a weakened catheter wall.  This ballooning is usually noticed at the end of the catheter before the thickened area at the hub, or on double lumen catheters at the “Y” area.  Polyurethane catheters (PowerLines™) are made of a more durable material and will not balloon.

A weakened wall may occur on new as well as old catheters.  The weakening may be a result of forceful flushing, sluggishness, or clotting, but most of the time it is unclear why it happens.

If a home TPN consumer notices bulging or ballooning of their catheter, a repair should be scheduled as soon as possible.  The catheter may be gently and cautiously flushed.  Observe the tubing during infusion. If bulging is large, you may need to lengthen the TPN cycle so that the solution goes in at a slower rate, creating less pressure on the catheter wall.

Repair requires a kit ordered from your catheter manufacturer.  When a new catheter is placed, obtain the identifying information and order your repair kit from your home infusion pharmacy.

A catheter repair procedure can be performed by a skilled home nurse, a physician’s office, hospital radiology department, or emergency room.  This is a sterile procedure that usually requires two people to complete.  Unfamiliar clinicians have easy access to the instruction sheet located on the top of the package.  Removing the sheet does not compromise the sterility of the repair kit contents.  Additional supplies such as flushes, gloves, and masks will need to be assembled before starting.

It is a good practice to observe your tunneled catheter tubing and site frequently, even when flushing and infusing TPN.  A watchful eye can many times prevent a full tear or hole.

For additional information on catheter repair see my "Springing a Leak" blog dated 9/20/06.