Indications
Tunneled catheters are used when a patient is in need of total parenteral nutrition (TPN), long-term antibiotics, IV fluid support, and delivery of chronic medications. By tunneling the catheter under the skin before it enters the vein, it is possible to leave the catheter in for a prolonged period of time, which makes these catheters different than PICC lines. We are able to place a number of different catheter types made of different materials in order to accommodate the individual needs of our patients.
Procedural Details
The placement of a tunneled catheter is done under sedation and with local anesthesia to ensure that the patients are comfortable throughout the procedure. The procedure begins with gaining access into a suitable vein in the body. The vein that is used is typically a larger vein either in the neck (internal jugular vein) or the chest (subclavian vein). At times, we may use a vein in the arm or the leg based on a patient's individual circumstances. Once a small needle is placed into that vein, a guidewire is advanced further into the vein to maintain position within the vein. At this point, we direct our attention to the site on the chest where the catheter will be exiting. A small incision is made at that site, and the catheter is advanced through that incision to the vein access site. The catheter is then advanced into the vein and positioned with its tip right near the heart. We determine the exact position of the catheter tubing using x-rays. Once the catheter is appropriately positioned, we place some stitches to help hold the catheter to the skin. Over time, there is a cuff on the catheter that is able to attach itself to the tissue under the skin, which helps keep it in place for a longer period of time. Following the procedure, you will spend 1-2 hours in our recovery area.
Post-Procedure Care
It is important to take care of a catheter after it is placed so that it can continue to work for as long as it is needed. The exit site for the catheter as well as the dressing over the catheter should be kept clean and dry. Patients can take a bath, but the catheter should be kept covered and dry.
It is possible that over time, clot can form inside the catheter or immediately outside the catheter. If this occurs, it may be difficult to draw blood or receive treatment through the catheter. This is usually treated by putting clot-dissolving medication called tissue plasminogen activator (tPA) directly inside the catheter. Another potential cause for diminished blood through a catheter is something called a fibrin sheath. As the body adapts to the catheter being present, a small film of tissue may form inside the body over the tip of the catheter. This can interfere with blood flow and may also be treated with clot-dissolving medication. At times, the presence of a fibrin sheath may require the catheter to be changed.
If the area around a catheter feels sore or looks red, it is possible that it may represent an infection of the catheter. This may especially be the case if there is fever, chills, or drainage from the catheter exit site. An antibiotic ointment may be used if the infection is limited to the catheter exit site. If there is drainage from the exit site or if the infection has spread throughout the body, antibiotics may be required.