referring now to fig1 a front view of an outer layer 100 of a central line access and support garment in accordance with an exemplary embodiment of the present invention is shown . the outer layer 100 comprised of material such as cotton , a stretchable synthetic fiber material ( e . g ., lycra ® by e . i . du pont de nemours and company ), jersey knit , or other fabric , provides an undershirt garment for appearance . it also protects an inner layer ( discussed below ) by reducing or eliminating frictional motion from movement of outer clothing worn by a patient . the outer layer 100 preferably has a neck line 105 just below the patient &# 39 ; s clavicular region 110 to avoid contact with a catheter line which may cross into the neck region . the shoulders 115 and 120 of the outer layer 100 are preferably broad enough to provide security without being uncomfortably tight . the outer layer 100 is preferably comprised of a front panel and a back panel , discussed below , as in a conventional manner for shirts . the front panel and back panel may be joined by stitching along sides 150 and 155 in a conventional manner . left and right shoulder portions or sections ( 115 and 120 , respectively ), each having front panel and back panel portions ( or sections ), are provided . the shoulder portions 115 and 120 of the front panel are preferably releasably joined to the shoulder portions of the back panel using releasable closure means , such as hook and loop fasteners ( e . g ., velcro ® hook and loop fasteners by velcro industries b . v . ); though other releasable closure means ( e . g ., buttons , snaps and zippers ) may be used without departing from the scope of the present invention . in an exemplary embodiment , snag free releasable closures such as snag - free velcro ® fasteners with buffers are used to eliminate snagging of adjacent fabrics and to resist lint build - up . the releasable closure means may allow adjustment of the shoulder portions to accommodate a range of patient physiques and preferences . by way of example and not limitation , the shoulder portions 115 and 120 of the front panel of the outer layer may have loop portions of a hook and loop closure 705 and 710 , as shown in fig7 horizontally across the width of the shoulder seams 115 and 120 . the back panel may have cooperating hook portions of hook and loop closures 715 , 720 , 725 , 730 vertically along the sides of the shoulder strap to allow for customized adjustment . in use , a patient may open the releasable closures 715 - 730 at the shoulder sections to facilitate removing and placing on the garment . additionally , a patient may open the releasable closures for one or both shoulders to facilitate access to the catheter line and / or port site . the outer garment preferably provides arm holes 135 and 140 large enough to comfortably accommodate a patient &# 39 ; s arms , but small enough to provide security for the catheter . adjustment of the releasable closure means 715 - 730 , preferably adjusts the sizes of the arm holes , allowing the garment to accommodate various physiques and preferences . the outer layer 100 is joined to the inner layer 300 shown in fig3 along the arm holes 135 and 140 , the shoulders 115 and 120 , and the neckline 105 as indicated by the dotted line 160 . the inner layer 300 is shorter in length than the outer layer 100 as indicated by the dotted line 170 . in fig2 a rear view of the outer layer 100 of the central line access and support garment in accordance with an exemplary embodiment of the present invention is shown . the outer layer 100 remains the same as described in fig1 . the neckline 205 is closer to the base of the neck of the patient to provide enhanced fit , comfort , and security . arm holes 135 and 140 remain the same as described in fig1 . the shoulder closures 115 and 120 remain the same as described in fig1 and the inner layer 300 is joined to the outer layer 100 as indicated by the dotted line 260 . the front panel and the back panel may be joined by stitching along sides 150 and 155 in a conventional manner . the inner layer 300 is shorter in length than the outer layer 100 as indicated by the dotted line 170 . the inner layer 300 of a garment , as shown in fig3 and 4 , in accordance with an exemplary embodiment of the present invention is of a similar shirt design as the outer layer . however , the inner layer is preferably smaller in width below the arm holes to allow for a relatively tight fit against the body and shorter in length , so as to be concealed by the outer layer . the material of the inner layer is preferably a stretchable fabric ( e . g ., lycra ® by e . i . du pont de nemours and company ), a tight jersey knit , a polyester stretch , a cotton , a blend of the above fabrics , or other suitable fabrics . the material should be chosen with patient comfort in mind , especially for patients with sensitive skin . the inner layer may otherwise follow the same general shirt pattern as the outer layer . in a preferred embodiment the inner layer 300 is attached to the inside of the outer layer 100 . for example , the neckline 305 of the inner layer may be stitched to the neckline 105 of the outer layer . shoulder seams for a front panel of the inner layer 310 and 315 may be attached to shoulder seams for a front panel of the outer layer 115 and 120 . likewise , shoulder seams for a rear panel of the inner layer may be attached to shoulder seams for a rear panel of the outer layer . preferably , upon opening releasable closure means 715 - 730 provided at the shoulders of the outer layer , the shoulders of the outer layer and the shoulders of the inner layer may be opened . thus , in an exemplary embodiment , the releasable closure means for the outer layer operate as releasable shoulder closure means for the inner layer . the sides 320 and 325 of the inner layer 300 are joined from the arm holes to the bottom hem 330 in a conventional manner , but independently from the outer layer 100 and sides 150 and 155 . a bottom hem 330 for the inner layer 300 is preferably comprised of an elastic band . for example , a ¾ - 1 ″ inch width band may be used , though narrower or wider elastic can also be used . lingerie or cotton elastic is preferred for comfort . the elastic is preferably smaller than the chest dimension for the size of the garment . for example ; a woman &# 39 ; s large may measure thirty inches at the chest and twenty - seven inches at the bottom hem . preferably , the elastic band provides a comfortable but secure fit to prevent the free ends of the catheter lines from falling below the hem under normal conditions , while protecting the catheter port site and lines . [ 0039 ] fig4 demonstrates the rear panel of the inner layer 300 . as described in fig3 the rear panel of the inner layer 300 remains the same with the exception that neckline 405 has been raised to the same level as the outer layer neckline 205 and is stitched in the same manner as 105 and 305 of the front panels . referring now to fig5 various potential port sites are conceptually illustrated , although not limited to , each by an x . a garment in accordance with an exemplary embodiment of the present invention conceals , and therefore secures , port sites within the boundaries of the garment . thus , the garment accommodates a wide range of port sites . it does not have openings or pockets that require certain specific port site locations . referring now to fig6 various locations and positioning of the external line portion of a catheter are conceptually illustrated , each by a curved line with an arrow . the external portion of each line starts at a port site 605 and ends with an access port ( denoted by an arrow ). though lines with a plurality of lumens or single lumen may be used , double lumen lines are conceptually shown in fig6 to illustrate a range of placements for a given port site . for clarification , lumens 610 and 625 stem from the same catheter line , as do 615 and 620 , 630 and 635 , 640 and 645 , and 650 and 655 . clips , which are commonly used with lines / lumens , are also not shown in fig6 . of course , the port site shown in fig6 is but one example of a port site . other port sites within the boundaries of the garment may be used without adversely reducing the efficacy of the garment . a garment in accordance with an exemplary embodiment of the present invention conceals and secures lines in a wide range of positions , as demonstrated but not limited to , 610 - 655 within the boundaries of the garment . thus , the garment allows positioning of a line to maximize comfort . by way of example , a patient wishing to sleep on his or her side or stomach may position the line ( and particularly the access ports and any clips , both of which can be hard ), in a location that enhances comfort . advantageously , the garment does not depend upon immovable openings or pockets for locating the line . according to an exemplary embodiment of the invention the inner layer is used with an outer layer . advantageously , the outer layer helps insulate the inner layer from stresses and strains attributed to movement of a patient &# 39 ; s outer clothing . without an outer layer , movement of outer clothing could possibly cause the inner layer to move against the patient &# 39 ; s body and thus cause complications with the port site and catheter lines . the outer layer is designed to reduce that risk allowing the inner layer to do what it is designed to do — protect and secure the port site and line . as described above , the outer layer may be joined to the inner layer at the neckline , but not at the bottom ( waist ) of the garment . thus , the bottom of the outer layer may shift independent of the inner layer . such independence , prevents snagging of the outer garment from imparting stresses to the central line protected by the inner layer . this attachment arrangement of an independently movable outer layer which is not attached to the inner layer at the bottom thus provides an important advantage over conventional single layer garments and garments with separate layers attached at the bottom and top . another important aspect of the invention is that the inner layer provides compressive support adequate to comfortably secure lines in a wide range of positions , without exerting excessive compressive pressure . in other words , the support provided by the inner layer of a properly sized garment according to the invention is adequate to secure a wide array of catheter lines and lumens against the wearer &# 39 ; s body in a wide variety of positions , without causing discomfort from excessive compression . preferably , the compressive support provided by a properly sized inner layer is substantially uniform , such that the force exerted against a catheter line at one position is substantially similar to the force exerted at another position ( i . e ., within the tightness range as described below ). in a preferred implementation , the magnitude of the compressive force provided by a properly sized garment according to an embodiment of the invention is within a tightness range , which is referred to herein as an effective tightness or an effectively tight fit . at the lower end of the range is a compressive force adequate to hold a line against a wearer &# 39 ; s body . at the higher end of the range is a compressive force that is a few times ( e . g ., two to three times ) the compressive force at the lower end of the range . below the lower end of the range , the inner layer would provide inadequate compression to secure a line against a wearer &# 39 ; s body . any fit that does not provide substantial excess space between the garment being worn and an intended wearer is at or above the lower end of the range , so long as it is sufficient to support a line against a wearer in a plurality of positions . because the exemplary outer layer is not intended to provide compressive support , it provides less than an effectively tight fit . above the higher end of the range , the inner layer would provide substantially excessive compression to secure a line against a wearer &# 39 ; s body and may eventually cause extreme discomfort . any fit that substantially exceeds compression to secure a line against a wearer &# 39 ; s body and causes appreciable discomfort is considered above the higher end of the range . sports bras and other similar athletic support garments for females fall within this category . those skilled in the art will appreciate that a garment in accordance with the present invention when worn by a person for whom the garment size is not intended ( e . g ., an extra large garment worn by a petite person or child , or a small garment worn by a large person ) will not fit the wearer properly . nevertheless , such a garment is still considered to provide an effective tightness or effectively tight fit if it provides sufficient compressive force to secure a catheter line , but not substantially excessive compression that will cause extreme discomfort when worn by a person for whom the garment size is intended . stretch fabrics capable of providing an effective tightness are used for the garment . the stretchable material content in the fabric may vary greatly , depending upon the amount of stretch and support needed , or desired . the fabric for the inner layer should be , but is not limited to being , a two - way stretch interlock knit . by way of example and not limitation , the materials may include blends of spandex with cotton , nylon , polyester , rayon , silk , or other stretchable materials . spandex is a generic name for a variety of elastic textile fibers made chiefly of polyurethane . lycra ® is one example of a spandex fabric available from e . i . dupont de nemours & amp ; co ., wilmington , del . various weights of fabric can be used for the inner layer and outer layer . for example , light , light / medium , medium , medium / heavy , and heavy weights may be utilized . different weights are preferred for different purposes . in a preferred implementation an 8 ounce ( or no less than 4 ounce ) double knit 2 - way stretch may be used for the inner layer , and an 8 ounce double knit cotton / spandex blend with 5 - 10 % spandex ( or a 4 ounce interlock cotton fabric ) may be used for the outer layer . the garment should be constructed with the stretch of the inner layer of the garment oriented across the body of the wearer ( i . e ., horizontally ), not up and down ( vertically ), such that the circumference of the inner layer is allowed to expand . all of these fabrics and blends can provide an effective tightness , excellent comfort and support . obviously , a complete array of colors and prints are suitable for both the inner layer and outer layer of the garment . it is the multi - directional stretch characteristics of the fabric , in conjunction with the specific design , that gives the garment , particularly the inner layer , an ability to conform to wearer &# 39 ; s physique and provide an effective tightness . the inner layer conforms to and provides a non - constricting , non - restricting , effectively tight fit . the chest and torso are allowed to expand and contract without appreciable resistance . the garment completely accommodates the line in various positions for comfort without pressing the line or lumens into the wearer &# 39 ; s body . those skilled in the art will appreciate that certain patterns of stretchable materials will achieve a determined effective tightness when worn by a person of an appropriate size . by way of example and not limitation , the inner layer constructions described in fig8 a and 8 b are considered to provide an effective tightness in accordance with the invention , when the materials for the inner and outer layers conform to the preferred material specifications set forth above . several aspects of conventional sports bras and other similar athletic support garments for females ( referred to collectively herein as “ sports bras ”) render such garments highly undesirable for use in securing a catheter line against a wearer &# 39 ; s body . most significantly , in sharp contrast to a garment according to the invention , conventional sports bras are designed to exert substantial compressive force to minimize breast motion . a strong elastic material holds the breasts firmly against the wearer &# 39 ; s body . while such compressive force is necessary for minimizing breast movement during rigorous activity , it is excessive for supporting a catheter line and leads to great discomfort , pain and swelling when exerted on a regular basis . the discomfort is particularly pronounced when a portion of the wearer &# 39 ; s body is swollen and tender , such as soon after implantation of a catheter line . such compressive force does not constitute an effectively tight fit as contemplated herein . another aspect of sports bras and certain other garments that render them highly unsuitable for supporting a catheter line is that the straps are often very thin . garments having thin straps are extremely problematic because the straps cut into the shoulders of the wearer , particularly larger and more robust wearers . catheters are often placed into a vein in a patient &# 39 ; s neck ( internal jugular ) or sometimes under the collar bone ( subclavian ) and tunneled under the skin . conventional thin straps of sports bras tend to cross a wearer &# 39 ; s collarbone over the tunneled catheter line . as conceptually shown in fig9 and 10 illustrate a sports bra and a garment with spaghetti straps and particular areas of conflict or discomfort with a catheter port or line . concentrated pressure from thin straps may cause discomfort by abrading or occluding a tunneled catheter line that cross a wearer &# 39 ; s clavicle . advantageously , a garment according to an exemplary embodiment of the invention avoids placing undue stress on the clavicle region by utilizing wide shoulder supports . although thin straps such as spaghetti straps may be stylish , they are unsuitable for a garment according to the invention . the shoulder portions of a garment according to the invention are preferably approximately 1½ inches or wider , which is several times wider than conventional spaghetti straps and bra straps . this width is considered minimally effective for avoiding stress concentrations that substantially increase discomfort . the shoulder portions may take the form of wide ( 1½ inch or wider ) straps , t - shirt - style sleeves , or any other shoulder form that provides at least 1½ inches of shoulder support material for avoiding severe stress concentrations at the shoulder region . the width of such shoulder supports is referred to herein as an effectively wide shoulder . another problem associated with conventional sport bras and other garments is that they are difficult to put on . for instance , sport bras are typically designed to be placed on over the head and require stretching of the elasticized band in order to do so . other garments may require tying of straps at the shoulders or buckling of straps across the wearer &# 39 ; s back . however , patients with implanted catheters frequently experience soreness , tenderness and an extremely limited range of motion , which significantly impairs their ability to put on such garments . advantageously , a garment according to the invention is easy to put on . a wearer can easily put on a garment according to an exemplary embodiment of the invention by pulling the garment over their head , in which case the shoulders may be fastened before or after the garment is pulled on . alternatively , the wearer can step into the garment , pull it up and then fasten the shoulder portions . because the shoulder portions are releasably joined , such as using hook and loop fasteners , they are easy to close when the garment is in place or before putting the garment on . the foregoing detailed description of particular preferred embodiments of the present invention , which should be read in conjunction with the accompanying drawings , is not intended to limit the enumerated claims , but to serve as particular examples of the invention . those skilled in the art should appreciate that they can readily use the concepts and specific embodiments disclosed as bases for modifying or designing other garments carrying out the same purposes of the present invention , and that such garments come within the scope of the invention . by way of example , and not limitation , garments with various additional pockets , pouches , and accessories come within the scope of the present invention . also by way of example and not limitation , garments comprised of other materials than those identified above , e . g ., breathable , lightweight and sheer materials , as well as synthetic materials or blended materials , whether now known or later developed , may come within the scope of the present invention . those skilled in the art should also realize that such equivalent garments do not depart from the spirit in scope of the invention as claimed .
a central line access and support garment provides an effectively tight inner layer to support and protect central line port sites and external lines , without applying excessive pressure that would cause discomfort . the garment protects a multitude of port site locations . releasable shoulder closures allow for easy access to the port sites and lines while providing an easy to wear garment for the patient . an inner layer is tight enough to protect the port site , securely holding the bandage , if used at the port site , against the patient &# 39 ; s body . the garment offers the flexibility of placing the external lines anywhere on the patient &# 39 ; s upper torso for comfort to the patient . an elastic band around the central body cavity serves as a protective shelf to keep external lines from hanging freely and thus pulling on the port site . an outer layer serves to protect the inner layer , absorbing stresses caused by outer garment movement and providing an additional layer of protection for the port site and external lines .