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A tunneled central vascular access device is used when access to a large vein is needed for a long period of time to provide intravenous nutrition or medications
A tunneled central vascular access device, also called a tunneled central venous catheter, is a thin plastic tube that is placed into a large vein in the body. It is used when venous access is needed for a long period of time to provide intravenous nutrition or medications.
It is commonly placed in the neck (internal jugular vein) but can also be placed in the groin (femoral vein), liver (transhepatic), chest (subclavian vein), or back (translumbar).
Tunneled central venous catheters create a transverse subcutaneous tunnel between the catheterized vein and the skin exit site. Thus, any catheter can be tunneled by placing it under the skin in the subcutaneous tissue. The tunneled catheter has a cuff attached to it that allows tissue and skin to grow around it, giving the line stability and reducing the risk of infection.
What is a tunneled central venous catheter used for?
Tunneled central catheters are used to access a vein over a long period of time (2 weeks to several months) to administer medications that cannot be administered through regular intravenous lines and to avoid frequent, painful needle insertions.
The device can be used to:
- Administer nutrition and fluids
- Administer chemotherapy, antibiotics, and hemodialysis
- Obtain blood samples
- Parenteral nutrition in those with poor peripheral access
What is the difference between a tunneled and non-tunneled catheter?
Central venous catheters can be tunneled or non-tunneled:
- Tunneled
- Placed under the skin (subcutaneous)
- Designed for longer use (weeks to months)
- Lower risk of infection
- Non-tunneled
- Placed into a large vein near the neck, chest, or groin
- Designed for temporary use (needs to be changed every few days to a week)
- Higher risk of infection
What steps are done before deciding on a tunneled central vascular access device?
Before deciding on which type of venous access to use, the following steps should be done:
- Thorough medical history and physical examination
- Basic lab work, including a complete blood count, metabolic panel, and coagulation studies
- Chest X-ray
- Electrocardiogram
- Assessment of risk factors, such as smoking, lung cancer, chronic kidney disease, acute renal failure, electrolyte abnormalities, and cardiac history
How is a tunneled central venous catheter inserted?
Most tunneled catheters come in a complete kit containing an introducer needle with a special radiopaque tip, catheter, and tunneling device. The procedure is done under sedation or anesthesia and typically takes approximately 30-60 minutes to complete.
- Doctors (general or vascular surgeons or interventional radiologists) will insert the catheter into a vein and thread it into the large vein carrying blood into the heart, using ultrasound or live X-ray (fluoroscopy) guidance.
- The other end of the catheter is tunneled under the skin and exits from the side of the chest.
- Two bandages are used, one over the insertion site (the neck) and the other over the catheter at the exit site (the chest), which requires a dressing every 7 days to prevent infection. The insertion and exit site should be kept dry for the first 48 hours following the procedure.
- Heparinized saline can be used to flush the catheter to keep blood from clotting in the catheter.
After the procedure, mild discomfort and slight pain may occur around the site for several days. This may be managed with pain medications such as Tylenol.
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What risks are associated with a tunneled central vascular access device?
Though the procedure is low-risk, patients with significant cardiac history may require cardiac risk stratification and medical optimization before undergoing the surgery. Risks may include:
- Infection (signs include redness or warmth, tenderness, pain, yellowish or greenish discharge, and fever of 100.4 F or higher)
- Significant bleeding
- Puncture of adjacent structures (other veins or arteries)
- Arterial puncture and subsequent hematoma formation
- Hemothorax (bleeding into the chest)
- Pneumothorax (air leakage in the cavity between the lungs and the chest wall, leading to lung collapse)
- Air embolism (blood vessel blockage caused by air bubbles in the circulatory system)
- Cardiac perforation and arrhythmias
- Dislodged catheter
- Occlusion or breakage of the catheter mandating removal or replacement of the catheter
The procedure is not recommended in the following cases:
- Severe, uncorrectable coagulopathies
- Uncontrolled sepsis
- Bacteremia
- Neoplasms
- Burns
- Trauma
- Cystic fibrosis requiring chest physical therapy
