What is a tunneled catheter?

Tunneled catheter is one of central venous catheters (CVC) or central lines that are inserted surgically into a large vein, commonly in the chest or neck. The "tunneled" aspect of the term is that part of the catheter that is routed beneath the skin (subcutaneously) from the entry site to the exit site. This subcutaneous tunnel provides a barrier which discourages the bacteria from entering the blood, hence lowering the chances of infection.

How is it placed?

A doctor, usually an interventional radiologist, places the catheter in a special suite. You'll have an IV inserted and be given medication to help you relax. Your neck and chest area will be cleaned with a special antiseptic soap, and a sterile drape will be placed over you. You'll receive a numbing medication to minimise discomfort, so you won't feel pain, but you may still feel a sense of pressure. Using an ultrasound machine, the doctor will find the correct vein. During the procedure, X-ray images are taken to confirm that the catheter is in the right location. Two small incisions are made: one at the insertion site near your collarbone and another where the catheter exits a few inches above your nipple. These incisions are then closed with stitches, medical tape, or special glue. The catheter itself will be secured with stitches and taped to your chest.

Why would I need this procedure?

There are several reasons you might need a tunneled catheter. These include:

Chemotherapy: For long-term cancer treatment.
Hemodialysis: A process to filter your blood when your kidneys aren't working properly.
Total Parenteral Nutrition (TPN): Receiving all your nutrients through a vein.
Blood transfusions: Getting blood from a donor.
Plasmapheresis: A procedure to remove or exchange certain parts of your blood.
Administration of fluids and medications: To give fluids or medicines that is harsh on smaller veins or need to be given over a long period.

Who shouldn't get this procedure?

You should not have this procedure if you have any of the following conditions:

A severe infection in your bloodstream.
A skin infection in the area where the catheter would be inserted.
A known allergy to the material the catheter is made of.
An uncorrectable bleeding disorder.
A blocked vein (thrombosis) where the catheter would be placed.

What are the benefits?

A tunneled catheter allows you to avoid repeated needle sticks for weeks, months, or even years. Some medications can only be given through this type of catheter. A doctor can also easily remove it once your treatment is complete.

What are the risks?

Like all medical procedures, there are some risks, though they are very low for this one. The most common risks are:

Infection: We use sterile techniques and a special antibacterial soap to reduce this risk greatly.
Bleeding: Bleeding is usually minimal and stops soon after the procedure.
The catheter doesn't work: This can happen if a clot forms at the tip or if the catheter moves. We suture and tape it in place to prevent movement. Depending on the catheter type, we might also use a small amount of a blood thinner (heparin) to prevent clots. We test the catheter right after placement to ensure it works properly.
Injury to surrounding structures (lung, artery): To avoid this, we use ultrasound and X-ray imaging to find the correct vein and ensure the catheter is properly positioned near the heart.

What can I expect Before the procedure?

Do I need to fast for the procedure?

Yes. You must stop eating and drinking 6 hours before the procedure.

Do I need to stop any medications?

Yes. If you are on any blood-thinning medications (like Coumadin, Lovenox, or Plavix), they are typically stopped before the procedure. You will get specific instructions on which ones to stop and when. You can continue to take aspirin.

How else can I prepare?

You should bring a list of all your medications with you. You also need to make sure you have someone to drive you home after the procedure.

What can I expect During the procedure?

Duration: The procedure typically takes 30 to 60 minutes.
Anesthesia: You will receive conscious sedation, which means you'll be relaxed and able to talk to the medical team, but you may not remember everything about the procedure.

How is the procedure done?

After you arrive in the procedure room, you will lie flat on the table.
The skin around your neck and chest will be cleaned with a special soap.
A blue drape will be placed near your head and across your chest to keep the area sterile.
The doctor will use an ultrasound to find the jugular vein in your neck.
Next, you will be given some numbing medication.
A small incision will be made above your collarbone to access the vein.
Once the vein is accessed, an X-ray will be taken to confirm the correct position.
More numbing medication will be injected on your chest where the catheter will be tunneled.
A second incision will be made at the exit site, usually a few inches above your nipple.
The catheter will then be passed under your skin.
You'll be asked to hold your breath as the catheter is placed into your vein.
Continuous X-rays will be taken during this time to ensure it's in the correct position.
Once placement is confirmed, your neck and chest will be cleaned, and stitches, special tape, and/or glue will be used to close the incisions and secure the catheter to your skin.
Finally, sterile gauze and a transparent dressing will be placed over the catheter and incisions until they have fully healed.

What can I expect After the procedure?

Expected discharge time: Up to 4 hours after the procedure.

Post-procedure care:

You may have some mild tenderness, bruising, and swelling where the catheter was placed, but these symptoms should disappear within a few days.
For minor discomfort, you can take over-the-counter pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil) unless your doctor has told you not to.
You must keep the catheter area dry and clean and should not submerge it in water.
You can shower 24 hours after the procedure. The site should be covered with plastic wrap and the edges taped to keep the dressing and catheter dry.
Avoid any strenuous exercise or activities that strain your neck and chest for the next 3 to 5 days to allow the incisions to heal.
If the dressing gets wet or falls off, put on a new, clean dressing and tape it in place.
Do not use any sharp objects near your catheter.
When the catheter is not being used, a nurse or doctor must flush it with a solution once a month to prevent clogging.
Call your doctor if you notice any unusual symptoms like fever, chills, pain, or swelling.

Why choose Tender Palm Super-Speciality Hospital for Tunneled Catheter Placement in Lucknow, India?

Tender Palm Super-Speciality Hospital is one of the best Tunneled Catheter Placement Hospital in Lucknow, India. Our team of experienced Nephrologists, Interventional Radiologists, and Critical Care Experts ensure safe and precise Tunneled catheter placement for patients requiring long-term dialysis, or intravenous therapies.