Tunneled Catheter Placement

A tunneled catheter is a thin, long, flexible, hollow tube that is placed inside a large central vein, most commonly in the neck (internal jugular vein) but may also be placed in the chest (subclavian vein), groin (femoral vein), or back (translumbar), while the other end of the catheter is tunneled under the skin to exit on the side of the chest. One end of the catheter remains outside the body and divides into 1, 2, or 3 smaller tubes called lumens. 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. A tunneled catheter is also commonly referred to as a tunneled central line or tunneled central venous catheter.

Indications

A tunneled catheter is indicated for patients who require long-term access to a vein for intravenous (IV) therapy, and who do not want to be poked with a needle every time they require treatment. In general, a tunneled catheter is usually recommended for:

• Administration of fluids and medications
• Chemotherapy
• Hemodialysis (filtering blood)
• Blood transfusions
• Total parenteral nutrition (TPN)
• Plasmapheresis (exchanging or removing blood elements)
• Obtaining blood samples

Preparation

Preparation for 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 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

A tunneled catheter is placed by a physician in the interventional radiology suite using ultrasound and live X-ray (fluoroscopy) for guidance. A tunneled central line is a catheter with a guidewire inside. This stiffens the tube so that it is easier to thread into a vein. In general, the procedure involves the following:

• You will be asked to lie down on the procedure table in a supine (face-up) position.
• You will receive IV sedation or general anesthesia to help you relax.
• Your physician will inject a numbing medication on the incision sites.
• Two small incisions are made, one at the insertion site, usually in the neck near your collar bone, and another at the tunnel exit site in the chest, which is usually a few inches above your nipple.
• Using ultrasound, the correct vein is identified.
• Using fluoroscopic guidance, your physician will insert the catheter into the vein, usually in the neck, and thread it into the large vein that carries blood to the heart. The other end of the catheter is tunneled under the skin and exits from the side of the chest.
• The incisions are then closed with special glue, tape, or stitches. The catheter will be sutured in place and taped to your chest.

Postoperative care

After the tunneled catheter placement procedure, you will be transferred to an observation room to be monitored for any adverse reactions. Since it is an outpatient procedure, you will be discharged home the same day. You may experience mild discomfort, pain, or swelling from the incision sites. Medications are provided as needed to address these. You should not get the catheter insertion area dirty or wet or submerge it in water. Do not shower for 24 hours after your procedure. Instructions on incision site care, bathing, and catheter care will be provided to keep the catheter and the wound area clean and dry. Avoid strenuous exercise or activities for at least a week to allow your incisions to heal. Call your physician for any abnormal symptoms such as persistent pain, swelling, chills, or fever.

Risks and Complications

Tunneled catheter placement is a procedure that is considered low risk. However, potential risks and complications may include:

• Infection
• Bleeding
• Catheter occlusion
• Collapse of the lung (pneumothorax)
• Air embolism (air in the veins)
• Bleeding into the chest (hemothorax)
• Injury to surrounding structures, such as a lung or artery

Benefits

Some of the benefits of tunneled catheter placement include:

• Eliminates the need for frequent needle sticks to give medications or draw blood
• Spares your blood vessels and veins from the irritating effects of IV medications
• Can be utilized for numerous types of IV therapies
• Can be utilized to get most blood tests
• Can be used at home, a nursing facility, or a hospital setting, and can remain in place for weeks, months, or even years, if required.

Summary

Tunneled catheter placement is a minimally invasive, simple, outpatient procedure that takes about an hour. It helps to deliver medications, fluids, and liquid nutrition, and carry out blood draws or blood transfusions more easily. A tunneled central line decreases the need for repeated needle sticks for intravenous access and can make your treatment more comfortable. A tunneled catheter can stay in your body safely for as long as a few years, and your physician can remove it when it is no longer needed.