Non Tunneled Catheter Placement

Non-tunneled catheter placement is a minimally invasive outpatient (same day) procedure in which a thin, long, flexible, Y-shaped tube is placed through one of the central veins located in your neck, groin, or chest to allow access to your bloodstream.

A non-tunneled catheter is a type of central venous catheter (CVC) and is also referred to as a non-tunneled central venous catheter or central line. There are 2 types of central venous catheters: tunneled and non-tunneled. Tunneled catheters have to be tunneled through a space underneath the skin and have both entry and exit sites, whereas non-tunneled catheters pass straight into the vein without any tunneling, and only have entry sites and no exit sites. The catheters may have one or more lumens or cavities for the transfusion of different fluids, as well as certain attachments.

Indications

Your physician may recommend non-tunneled catheter placement to administer intravenous fluids, nutrition, or medications on a short-term basis in acute or emergency situations for up to two weeks. It can also be utilized for blood collection if needed, and for hemodialysis while you are waiting for a tunneled catheter, peritoneal dialysis catheter, or if you have an arteriovenous fistula.

Preparation

Preparation for non-tunneled catheter placement may involve the following steps:

• Providing your physician with a list of medications and supplements you are taking
• Adjusting the dose of medications you are on, or refraining from certain medications, such as blood thinners, which may affect blood clotting
• Informing your doctor of any recent illnesses or other medical conditions you have, such as kidney disease or heart disease
• Arranging for someone to take you home after the procedure
• Refraining from eating or drinking at least 6 hours before the procedure
• Signing an informed consent form after the pros and cons of the procedure have been explained

Surgical procedure

Non-tunneled catheter placement is performed by a vascular physician and interventional radiologist in an interventional radiology suite using image guidance (ultrasound and x-ray) to locate the vein that is being used. In general, the procedure involves the following:

• You will be placed on the procedure table in a supine (face-up) position.
• You will receive either local anesthesia with sedation or general anesthesia to keep you relaxed and comfortable.
• Your physician will inject a numbing medication on the incision site.
• Using image guidance, your physician will insert a non-tunneled catheter directly into a large vein in your neck or chest. In some cases, the catheter may be inserted into a large vein in your leg.
• You will likely have a couple of stitches at the catheter insertion site to hold the catheter in place.
• The catheter will have 2 lumens (tubes) coming from your neck or chest. Each lumen has a clamp, a needleless connector (also called a clave), and a disinfection cap on the end. These lumens are utilized to provide fluids, medicines or blood products, or to draw blood samples.
• An X-ray is taken after catheter placement to ensure the tip of the catheter is in the right position and is safe to use.

Postoperative care

After the procedure, you will be transferred to an observation room and discharged home the same day once you are deemed stable. You may experience pain, swelling, or discomfort from the catheter insertion site. Medications are provided as needed to address these. Instructions on catheter management will be provided, including how to prevent getting the catheter area dirty or wet. Do not shower or take a bath for 24 hours after your procedure. Instructions on incision site care and bathing will be provided to keep the wound clean and dry. You should avoid strenuous exercise or activity for at least a week to allow the incision site to heal. You will not be able to drive for 24 hours after the procedure, but you may return to other daily activities. A follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Non-tunneled catheter placement is a safe procedure. However, as with any procedure, some risks and complications may occur, such as:

• Infection
• Catheter blockage
• Injury to blood vessels
• Air embolism (air in the veins)
• Blood clot
• Bleeding
• Break or leak in the catheter

Summary

A non-tunneled catheter placement is a simple, safe, minimally invasive, and same-day procedure that takes about an hour. It is designed for short-term use and helps to deliver medications, fluids or liquid nutrition, and to carry out blood draws or blood transfusions.