A catheter is a hollow tube inserted into a blood vessel, duct, or body cavity to keep the passageway open and allow for drainage or insertion of fluid. Attached to the catheter, but lying outside of the body, is the lumen. When three separate lumens are attached to a single catheter, it is called a triple lumen catheter. Through the different lumens, or ports, medical staff can draw blood and administer fluids or medications. This type of catheter allows healthcare professionals to perform many different procedures without the patient having to undergo multiple needle pokes.
Triple lumen catheters are used to access central veins. The distal end of the catheter is inserted into the internal jugular, the vena cava, or the subclavian vein, while the proximal end is sutured to the skin. The entire procedure takes place in an operating room, and may take from two to four hours to complete. Chest X-rays after placement of the catheter ensure that no complications occurred during insertion.
There are three commonly used types: the Hickman®, Broviac® and Groshong®. All of these catheters are made from silicone rubber and all three are tunneled under the skin to reduce the risk of infection. The Broviac® is typically used in pediatric patients. For patients receiving long-term treatment, these catheters can be left in place for several weeks or months.
The Hickman® and Broviac® catheters have an open distal end, while the Groshong® has a closed end. The distal end of the Groshong® has slits that act as a valve, which prevents blood from flowing into the lumen unless suction is applied from a syringe. For a patient, this makes the Groshong® catheter easier to care for because it does not require clamps on the ends. The Hickman® and Broviac® catheters also require regular flushing with anticoagulant medications to prevent blockage.
A triple lumen catheter may be used for patients requiring total parenteral nutrition, such as burn or coma patients. These patients are critically ill and may have reduced access to veins because of skin damage. The catheter allows the medical team additional access ports for medications or blood tests, while providing one port dedicated to intravenous nutrition. Cancer patients undergoing chemotherapy may also have these devices to allow separate ports for chemotherapy administration, blood sampling, and pain medication.
It is extremely important that patients with triple lumen catheters follow proper sterile technique. The catheter leads directly into a vein, so bacteria has a direct path to the blood system. The risk of catheter-related sepsis, or infection, is thought to be much higher in those with multiple lumens, and has been reported to be up to 25% higher than in single lumen catheters. Consistent adherence to sterile procedures minimizes the risk of infection to the patient.