Novel technique for tunnelling paediatric cuffed venous catheters

Abstract

modate large canal diameters and provide excellent pressurisation. TECHNIQUEThe technique involves the application of Spongostan ® foam on to a Surgicel ® mesh, which is rolled on to the Spongostan ® foam, forming a uniform cylindrical structure. The diameter of the restrictor is adjusted to the desired femoral canal diameter by increasing the thickness of the Spongostan ® foam. The restrictor is inserted into the medullary canal and guided to the appropriate position using a standard cement restrictor inserter, where it expands uniformly, creating an effective restrictor. Bone cement is applied and pressurisation commenced prior to implant insertion. The bespoke restrictor glides with minimal resistance and maintains its form during insertion. DISCUSSIONNumerous plug designs and materials are available, ranging from nonresorbable to resorbable. All restrictors should avoid intramedullary cement leakage and plug migration during cement and stem insertion to ensure adequate intramedullary pressures. The use of the Surgicel ® -Spongostan ® haemostatic restrictor overcomes some of the limitations of standard cement restrictors. These include the ability to bypass a narrow femoral isthmus, accommodate large femoral canals (particularly in revision procedures), and the flexibility of adjusting the restrictor to the desired diameter of the medullary canal, providing a bespoke cement restrictor.