What is a Tunneled Infusion Catheter?
A vascular access procedure involves placing a thin hollow plastic tube, or catheter, into a vein to permit drawing blood tests, and giving medications, fluids and nutrition, or transfusions directly into the bloodstream.
When an IV line is necessary for longer than a few days, or for certain medications or nutrition that must be delivered into a very large or central vein where there is a large blood flow to dilute the medicine, then a central access catheter can be used.
A tunneled catheter usually enters the skin below the collar bone (clavicle) and travels under the skin to enter the jugular vein, with its tip in the very large central vein (the vena cava). This type of catheter is intended for long-term use (up to many months). Smaller diameter tunneled catheters may be used for giving medications, while larger diameter catheters are used for dialysis. The tunneled catheters are designed with a cuff that resides under the skin, to make the catheter more secure from being pulled out and to prevent infection.
How should I prepare?
No special preparation is required. Tunneled catheters are easily and quickly placed and usually done without the need for sedation.
You should inform your physician of all medications being taken and any allergies, especially to iodinated contrast material or latex gloves. Women should always inform their physician and X-ray technologist if they are pregnant.
How is the procedure performed?
All procedures will be done in a special procedure room, on a fluoroscopy table where real-time X-ray imaging can be done to make sure the catheters are correctly placed.
You will be asked to remove clothing above the waist and wear a gown. You will lie flat on your back. One dose of an intravenous antibiotic will be given at the start of the procedure. Strict sterile technique will be used. The skin will be cleansed with antiseptic, and a local anesthetic given. Ultrasound is used to find the needle puncture site for the appropriate vein, and a wire is placed through the needle into the vein, and the position is checked by fluoroscopy.
A tunneled catheter enters the skin at a distance from the initial puncture site, so a second injection of local anesthetic and a small skin nick are made, and the catheter is placed from there under the skin to connect with the first puncture site, and then the catheter is placed into the large vein. The initial puncture site will be closed with either a suture or skin adhesive (glue) or both. The outside part of the catheter is fixed to the skin, usually with a suture, and covered with a dressing.
What will I experience during and after the procedure and how will I get my results?
Local anesthetic stings at the first moment of injection, but you should only feel pressure after that. You will need to keep the catheter covered with plastic wrap while showering. Do not swim or immerse the catheter in water. The catheter needs to be flushed with a blood thinner after every use. When the time comes, it must be removed by a physician.
Call your physician if the catheter malfunctions, if there is bleeding or redness or swelling of the skin around the catheter, or if you develop a fever.
The interventional radiologist will determine that the catheter has been placed correctly. At each use of the catheter, your health care professional will determine that the catheter is functioning by aspirating blood from the catheter before injecting medicine.
What are the benefits and risks?
A tunneled infusion catheter allows medicines, fluids, or nutrition to be given multiple times intravenously, and blood tests to be taken, without the need to have a separate venous puncture each time. The placement of the catheter tip in a large central vein allows some drugs that are toxic or irritating in very small veins to be used safely.
Patients can receive IV medications at home or in an extended care setting such as a nursing home.
Any procedure that involves placing a catheter within blood vessels carries certain risks, such as bleeding and bruising, damage to the blood vessel, or infection. Immediately call your physician if any of the following occur:
- The catheter can become infected if it is not handled properly, or if there is a bloodstream infection. his may become apparent by redness and swelling around the catheter or unexplained fevers.
- The catheter may become dislodged, and need to be replaced.
- The catheter may become clogged with blood clot, and need to be exchanged for a new one.
- The vein containing the catheter may become clotted and cause swelling of the arm, shoulder or neck on the same side.
Air may enter the bloodstream if the outside part of the catheter breaks, or if the catheter is not clamped when attaching or removing a syringe. If you develop shortness of breath or chest pain from air entering the catheter, immediately clamp the catheter and lie down on your left side and call 911.
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