Non-Tunneled Central Venous Catheter

Non-tunneled central venous catheters are catheters (tubes) that go directly into a major vein in your chest or groin. Central venous catheters are also known as central lines.

Non-tunneled catheters go into central veins, which are veins near the center of your body (usually in your chest or upper thigh). Their name comes from how the insertion of these catheters is more direct. Once the catheter tube is inside your body, a healthcare provider threads it toward your heart. The end of the tube sits either right outside your heart (in your superior vena cava) or just inside your heart (in the right atrium, which is the first chamber blood goes through in your heart).

Central lines are a common treatment across many different areas of medicine. Providers can use them for purposes like:

• Dialysis and apheresis
• Giving IV medicines, fluids and nutrition
• Drawing blood regularly for testing

Non-tunneled catheters usually aren’t meant for long-term use. How long they stay in can vary. Your healthcare provider can tell you what to expect.

Placement of non-tunneled catheters

Non-tunneled catheter placement usually happens in an emergency room or during a hospital stay. Before inserting a non-tunneled catheter, your healthcare provider will use a local anesthetic to numb the area. That way, you won't feel pain while they place the catheter.

There are two main ways providers can insert the catheter. They can do the insertion with an incision or without an incision. This partly depends on the specific catheter insertion device they have available.

Making an incision ensures the opening in your skin is wide enough for the catheter tube to go in. But some catheter kits don’t need an incision. That’s because the tube goes directly through your skin and into a vein. Your provider can tell you more about which technique they recommend.

There are also multiple veins your provider can choose from when deciding how to place the non-tunneled catheter:

• Internal jugular (IJ) vein (central upper chest)
• Subclavian (SC) vein (collarbone area)
• Femoral vein (upper thigh/groin area)

Providers insert non-tunneled catheters using an ultrasound for guidance. That makes placement easier, in turn making the process faster and lowering the odds of any complications. Once the catheter is in place, your provider will stitch the catheter line to your skin to hold it there.

What are the potential benefits and risks of non-tunneled catheters?

Non-tunneled catheters' benefits include:

• Easier IV access: Providers can use the catheter many times instead of inserting IV needles through your skin.
• Fast placement: It only takes a few moments to place a non-tunneled catheter. Faster placement means faster treatment. And that can be a big help if providers can’t easily insert an IV into places like your arms or hands.
• Multipurpose access: Central catheters are two-way. Your provider can use them to draw blood for testing, or to give you medicines or fluids.

Non-tunneled catheters do have risks and drawbacks. They include:

• They aren’t meant for long-term use.
• They’re more prone to infections than tunneled catheters.
• There's a risk of blood clots.
• A catheter tube sometimes has blockages (occlusions).
• Part of the catheter may shift out of place, bend or kink.
• During placement, there’s a small risk of puncturing nearby arteries or a lung.
• In rare cases, an air bubble may enter your bloodstream and cause an air embolism.
• The catheter tube may leak, which can cause extravasation.

Your healthcare team will do all they can to prevent any complications. They’ll also guide you on what to watch for and how to lower your odds of complications.

When should I call my healthcare provider?

Your healthcare team needs to know about any changes to the site around the catheter or any symptoms you notice. Some of the warning signs you should tell them about include:

• Pain, skin discoloration, swelling or stiffness around the catheter site
• Fever, vomiting or malaise
• Any changes to the catheter line itself, like cracking or splitting (this is rare)
• If you notice any part of the catheter changing position, or you feel any changes inside around the catheter site or in your chest

Your healthcare provider can also tell you about other warning signs and what you should do if you see them.

Non-tunneled catheter dos and don’ts

If you have a non-tunneled catheter, your healthcare provider will explain some of the things that you should keep in mind to avoid complications.

Here's what to do:

• Do wash your hands with soap and water before you touch the catheter or area around it. If you’re staying in a hospital and have a catheter in, you shouldn’t touch it; the only people who should touch it are healthcare professionals.
• Do look at your bandages daily, if possible, and tell your provider if the bandages are soiled or damaged.
• Do avoid pulling or snagging the catheter on something around you.

Here's what NOT to do:

• Don't pull, tug or pinch the catheter line.
• Don't try to move around or lift things without your provider clearing you first.
• Don't get the catheter wet or clean the skin around it with anything your care team hasn’t specifically approved.

Ask your care team what you can do to care for your catheter site. They can guide you and will be happy to answer questions.