Tunneled central venous catheter

A tunneled central venous catheter is a small plastic tube that is placed into a major vein that can remain in place for long-term use. A tunneled path is formed away from the actual vein entrance point and serves to decrease the risk of infection. The tunneled aspect of the procedure permits the catheter to remain in place and available for use longer than other temporary venous access catheters such as peripheral IV's, peripherally inserted central catheters (PICC's) or non-tunneled temporary central lines.

Conditions treated

• Long term (typically greater than 7 days) infusion of medications:

• Antiobiotics
• Chemotherapy
• Various specialized medications that are more effective when given through the vein
• Rapid hydration and Nutrition (children who can't be fed into their stomach or intestines)

• A route to perform dialysis (children with renal failure)
• Children that require frequent blood draws (reduces need for repeat skin punctures)
• Children with limited peripheral IV access

Treatment

The child will be positioned on the imaging table. The imaging technique usually starts with ultrasound to identify an appropriate central vein that would be amendable for venous access. This is typically in the neck or the groins of the legs. Some other unusual locations could include the veins in the liver or kidneys.

The skin surface will be cleaned to allow for a sterile skin puncture site. Local anesthetic will be introduced to help with comfort at the expected skin puncture site prior to a small skin nick being made to permit insertion of the needle into the vein. A wire will be passed through the needle into the vein and towards the heart while using live x-rays (fluoroscopy) in order to monitor the progress of the wire safely.

The central venous catheter will then be advanced under the skin (tunneled path) typically in the chest towards the neck. Occasionally a different vein will be used for access and therefore the tunneled path will be in the location of the vein accessed. The central catheter will then be advanced over the wire into the central vein used for access and positioned with its tip in a large vein near the heart with fluoroscopy guidance to ensure real-time accurate positioning. The catheter will then be secured into place on the skin surface and covered with bandaging.

The procedure typically requires 30 - 60 minutes to complete. Typically, sedation or anesthesia will be used to help facilitate the successful completion of the procedure. This helps to minimize anxiety for the child and decrease risk of complications as a result of movement during the procedure.

The catheter will be available for use immediately following the procedure. Once recovered from sedation/anesthesia your child would be able to participate in activities as tolerated. There can be some mild bruising or soreness along the tunneled path for several days following the procedure. The discomfort can typically be treated with acetaminophen (Tylenol ®) or ibuprofen.

The insertion site should be kept dry for the first 48 hours following the procedure. Afterwards it is OK to have showers and baths. Try to keep water from directly spraying the insertion site with showers (face away from the spray). The site should be kept above water if taking a bath. The site should be dried with a clean dry towel following a shower or bath.

When the catheter is no longer required or your child has completed therapy, the catheter can be removed by interventional radiology with some local numbing at the insertion site. Frequently this can be performed without local numbing medication.

Your child can resume activities as tolerated following recovery from sedation and/or anesthesia.

Benefits and risk of the treatment

• The catheter can remain in place and functional for longer periods than non-tunneled temporary central lines or peripheral IV's
• Tunneled central catheters have decreased infection rates.
• Tunneled central catheters have increased options and capabilities for medication infusion options compared to peripheral IV's or non-tunneled central lines.

• Any procedure where the skin is penetrated carries a potential risk of infection. The chance of developing an infection that requires added antibiotic treatment appears to be less than one in 1,000.
• Rarely significant bleeding may occur, air leak into the chest (pneumothorax) or air leak into the vein and heart (air embolism).
• The tunneled central venous catheter can become dislodged, catheter broken or occluded requiring replacement or removal of the catheter.