A tunneled cuffed CICC should be considered as a long-term central VAD, provided it has been well implanted (important point: the cuffed must be inside the tunnel, at 2 cm or more from the exit site).
The CICC can be inserted by ultrasound-guided puncture and cannulation of veins of the supraclavicular area (internal jugular,subclavian, or brachio-cephalic vein) or of the infra-clavicular area (axillary vein), but always tunneled towards the infra-clavicular area.
We recommend to use power injectable cuffed catheters, in latest-generation polyurethane, open-ended, nonvalved. This type of catheters will be associated with minimal risk of malfunction and mechanical complications. They are available in various sizes (5Fr, 6Fr, etc.), both single and double lumen. The silicone cuffed CVCs used in the past (cuffed Groshong, Hickman, Broviac, Leonard) are now to be considered obsolete and should be abandoned, since they do not have any advantage in terms of biocompatibility but instead have many disadvantages (difficulty in securement, low flow, fragility, tendency to dislocation and to tip migration, high incidence of lumen occlusion, difficult disobstruction if occluded, impossibility of use at high pressures).
Interestingly, the cuff becomes efficient for stabilization purposes only two to three weeks after implantation (i.e. only after the development of adhesions between the cuff and the subcutaneous tissue); in this first period after implantation, the catheter must be temporarily stabilized with a sutureless system with skin adhesiveness (or even with a SAS).