Tunneled Catheter Insertion – The Procedure

Tunneled catheter insertion is a procedure to insert a thin, flexible tube (catheter) into a vein. The catheter makes it easier to draw blood, give blood products, remove waste products from the blood (hemodialysis), and give medicines. This procedure is usually done when the bloodstream needs to be accessed many times over a long period of time. The procedure may vary among health care providers and hospitals.

Typically, a tunnel catheter is inserted in the neck, chest, or groin. During the procedure, the catheter is tunneled under the skin. This means that the catheter is inserted under the skin and then moved away from the insertion site. Placing the catheter a few inches away from the insertion site reduces the risk of infection.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Damage to surrounding structures or organs.
• Damage to the blood vessel that the catheter is inserted into.
• Insertion of the catheter into the wrong blood vessel.
• Development of:
  • A kink, hole, or crack in the catheter.
  • An air bubble in the catheter.
• Blockage of the catheter.
• Blood clots near the catheter.
• Irregular heartbeat (rare).
• Lung collapse (rare).

What happens before the procedure?

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• Follow instructions from your health care provider about eating or drinking restrictions.
• Ask your health care provider how your surgical site will be marked or identified.
• You may be given antibiotic medicine to help prevent infection.
• You may have a blood or urine sample taken.
• Plan to have someone take you home after the procedure.
• If you will be going home right after the procedure, plan to have someone with you for 24 hours.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
  • Hair may be removed from your surgical area.
• An IV tube will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
  • A medicine that is injected into your spine to numb the area below and slightly above the injection site (spinal anesthetic).
  • A medicine that is injected into an area of your body to numb everything below the injection site (regional anesthetic).
• An ultrasound of your insertion site may be done. An ultrasound is a test that uses sound waves to make an image of your insertion site. This helps your surgeon see your blood vessels more clearly.
• Two incisions will be made at your insertion site. Usually, the incisions are a few inches away from each other.
• A tunnel will be made under your skin, between your two incisions.
• A small wire (guidewire) will be inserted into your vein. The guidewire will help to move the catheter into your vein.
• The catheter will be inserted into your vein and threaded through the tunnel under your skin.
  • Your surgeon may use X-ray equipment to watch the catheter being inserted. This allows your surgeon to watch the catheter on a live display while guiding it into place.
  • The cuff of the catheter will remain in the tunnel under your skin. The cuff helps to keep the catheter in place.
• Stitches (sutures) will be used to partially close your incision and to hold your catheter in place where it exits your body.
• An X-ray may be done to make sure your catheter is in the right place.
• Caps will be screwed onto the ends of the catheter that are outside of your body.
• The incision that was used to insert your catheter may be closed with sutures, skin glue, or adhesive strips.
• Bandages (dressings) will be placed over your incisions.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
• You may continue to receive fluids and medicines through an IV tube.
• You may have pain and swelling at your insertion site. Medicines will be available to help you.
• You may have to wear compression stockings. These stockings help to prevent blood clots and reduce swelling in your legs.
• You will be encouraged to move around as much as possible.
• Do not drive for 24 hours if you received a sedative.

Tunneled Catheter Insertion, Care After

These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

What can I expect after the procedure?

After the procedure, it is common to have:

• Some mild redness, swelling, and pain around your catheter site.
• A small amount of blood or clear fluid coming from your incisions.

Follow these instructions at home:

Incision care

• Check your incision areas every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.
• Follow instructions from your health care provider about how to take care of your incisions. Make sure you:
  • Wash your hands with soap and water before you change your bandages (dressings). If soap and water are not available, use hand sanitizer.
  • Change your dressings as told by your health care provider. Wash the area around your incisions with a germ-killing (antiseptic) solution when you change your dressing, as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.

Catheter Care

• Wash your hands with soap and water before and after caring for your catheter. If soap and water are not available, use hand sanitizer.
• Keep your catheter site and your dressings clean and dry.
• Apply an antibiotic ointment to your catheter site as told by your health care provider.
• Flush your catheter as told by your health care provider. This helps prevent it from becoming clogged.
• Do not open the caps on the ends of the catheter.
• Do not pull on your catheter.
• If your catheter is in your arm:
  • Avoid wearing tight clothes or tight jewelry on your arm that has the catheter.
  • Do not sleep with your head on the arm that has the catheter.
  • Do not allow your blood pressure to be taken on the arm that has the catheter.
  • Do not allow your blood to be drawn from the arm that has the catheter, except through the catheter itself.

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do not lift anything that is heavier than 10 lb (4.5 kg) for 3 weeks or as long as told by your health care provider.

Driving

• Do not drive until your health care provider approves.
• Do not drive or operate heavy machinery while taking prescription pain medicine.

General instructions

• Follow your health care provider’s specific instructions for the type of catheter that you have.
• Do not take baths, swim, or use a hot tub until your health care provider approves.
• Follow instructions from your health care provider about eating or drinking restrictions.
• Wear compression stockings as told by your health care provider. These stockings help to prevent blood clots and reduce swelling in your legs.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have more fluid or blood coming from your incisions.
• You have more redness, swelling, or pain at your incisions or around the area where your catheter is inserted.
• Your incisions feel warm to the touch.
• You feel unusually weak.
• You feel nauseous.
• Your catheter is not working properly.
• You have blood or fluid draining from your catheter.
• You are unable to flush your catheter.

Get help right away if:

• Your catheter breaks.
• A hole develops in your catheter.
• Your catheter comes loose or gets pulled completely out. If this happens, press on your catheter site firmly with your hand or a clean cloth until you get medical help.
• Your catheter becomes blocked.
• You have swelling in your arm, shoulder, neck, or face.
• You develop chest pain.
• You have difficulty breathing.
• You feel dizzy or light-headed.
• You have pus or a bad smell coming from your incisions.
• You have a fever.
• You develop bleeding from your catheter or your insertion site, and your bleeding does not stop.