Milestones To Be Remembered

One benefit of getting older is the privilege of remembering when certain milestones in history occurred. From time to time, I have to remind my grandchildren that I was not with George Washington at Valley Forge nor was I around during the Civil War. However, I am honored to have been around for numerous monumental events. I well remember watching the first moon landing on television (admittedly in black and white!). I have seen numerous medical developments, including mechanical suturing devices for anastomosing segments of bowel and the advent of laparoscopic operations. Additionally, I have witnessed discoveries and developments that made operating on the heart and blood vessels possible. One development often taken for granted is that of the indwelling central venous catheter. Gow and colleagues¹ said “the tunneled central venous catheter has been one of the most crucial important advances in medicine in our lifetime.” When considering the importance of being able to access large veins of the body and utilize them for patient care, it seems hard to imagine that we have not always had that ability. When I first heard of using this type of venous access, I was thrilled to think there would be no more emergency midnight venous cutdowns!

The first tunneled central venous catheter was developed just over 50 years ago by Dr. Stanley Dudrick.² As with most inventions, the use of this type of catheter was the solution to the problem of providing patients with nutrition through the venous system rather than the intestinal track.³ After developing the initial formula for the intravenous feeding, Dr. Dudrick tried administering it via his own peripheral veins. He quickly discovered this would not work due to the nutritional fluid damaging the veins.² His next approach was to access the central veins through the percutaneously accessed subclavian vein — but what kind of catheter would be useful? All commercial catheters caused an inflammatory response that would lead to clotting.⁴ To solve the problem, Dr. Dudrick went to the hardware store and bought polyvinyl tubing, which proved to work well without an inflammatory response.⁴ His intravenous feeding technique proved effective when he was able to sustain an infant with intestinal atresia for more than 22 months.⁵ His life-saving techniques, which are still in use today, would not have been possible without the central venous catheter he developed.

Dr. Dudrick continued to work on his catheter, eventually developing techniques to make the catheter radiopaque and adding the Dacron cuff to reduce the possibility of catheter dislodgement and infection.² In 1970, I had the honor of meeting Dr. Dudrick and listening to him discuss his total parenteral nutrition — very little was said about his catheter that made all of this possible. As others have modified the original central venous catheter to meet specific needs, the original concept has opened many new fields of investigation and treatment, such as cardiac catheterization, pacemaker placements, cancer therapy, and hemodialysis, and led to the development of the peripherally inserted central catheter that is used worldwide today.

Looking back at all of this, it has been interesting to have seen these developments and met those who successfully changed the way medicine is practiced. It is always important to remember that most advances occur because of a specific need someone meets — and the hardware store is not a bad place to shop for things that will advance science!

Terry Treadwell, MD, FACS
woundseditor@hmpglobal.com