Tunneled Catheter

A tunneled catheter is a type of central venous catheter (CVC). Its name comes from how it “tunnels” under your skin before entering a central vein. Central venous catheters are also known as central lines, and they’re important for certain types of treatments, including lifesaving ones.

Central venous catheters are tubes that go into a vein and lead down to your heart. The end of the catheter tube may sit in the superior vena cava, just outside your heart, or in your heart’s right atrium. That’s the first chamber that blood enters when it goes into your heart.

Healthcare providers use tunneled catheters for:

• Giving IV medicines and fluids
• Hemodialysis and apheresis
• Needing to take blood frequently for testing
• Parenteral nutrition

While tunneled catheters can be long-term or even permanent for some people, they can also be a short-term option until a long-term treatment is possible. Examples include people who need surgery to create an arteriovenous fistula (when a surgeon makes one, it’s known as a dialysis fistula) or arteriovenous graft. Both of those are common for people who need long-term dialysis.

Types of tunneled catheters

There are two types of tunneled catheters:

• Cuffed tunneled catheters
• Subcutaneous ports

Cuffed tunneled catheters have a small ring of fiber material around their tube. Once the catheter is inside your body, your body will heal around the ring. Some of the scar tissue that forms will grow into the ring, locking the tube into place. One end of the catheter stays outside your skin. That end has attachments that providers can use to take blood, give medicines and more. This type is semi-permanent, meaning it should stay in place until you have a procedure to remove it.

Subcutaneous ports connect to a tunneled catheter, but the port doesn’t stick out through an opening in your skin. Instead, the port sits just under your skin. All a provider needs to access the port is a special needle made for the port itself.

Placement of tunneled catheters

Placing a tunneled catheter is usually something a surgeon does in an operating room. Doing this in a sterile environment is best to lower the odds that you get an infection. Before they start, they’ll sterilize your skin and inject a local anesthetic to numb the area. That way, you won’t feel pain during the procedure.

To place the catheter, they’ll make a small incision in your skin near a major vein, usually one in your chest or groin. Then, they’ll insert the catheter tube into the incision and run it underneath your skin for a short distance. Once there, they’ll insert the tube into the vein, similar to using a needle to enter a vein on your arm or hand.

Once the catheter is inside the vein, the surgeon will thread the catheter tube through your veins and down into the right atrium of your heart. That’s the first chamber that blood goes through once it’s inside your heart.

But placing a tunneled catheter isn’t always done the same way. The procedure can vary based on:

• The type of tunneled catheter
• Which vein the catheter starts in
• Your health history and, if available, your preferences (like if you would prefer a subcutaneous port because you swim regularly for physical activity)

There are three major veins that healthcare experts will use for tunneled catheters. They are your:

• Internal jugular (IJ) vein: The insertion point is near where your neck meets your chest.
• Subclavian (SC) vein: The insertion point is near your collarbone.
• Femoral vein: The insertion point is on your upper thigh near your groin.

The type of catheter matters when it comes to selecting which site to use. Cuffed tunneled catheters work with all three major vein sites. Subcutaneous ports are only an option for tunneled catheters using the IJ and SC veins. Your provider can tell you more about your options and offer recommendations.

What are the potential benefits and risks of tunneled catheters?

Tunneled catheters have clear benefits under the right circumstances. The benefits include:

• Long-term IV access: Providers can use the catheter many times instead of inserting IV needles through your skin.
• Multipurpose use: The tunneled catheters are useful for taking blood for testing and for giving medicines, fluids and IV nutrients.
• Lower odds of dangerous infections: The tunneling approach makes healthcare-associated infections like central line-associated bloodstream infections less likely.
• Appearance: You can hide cuffed tunneled catheters easily with clothing. Tunneled catheters with ports are also easy to hide since they’re under your skin.
• Minimal interference with daily routine: You can go about your daily routine with tunneled catheters. With cuffed tunneled catheters, it’s OK to bathe or shower (but don’t immerse them in water). If you have a tunneled catheter with a port, you can bathe, shower or swim normally.

But tunneled catheters also have risks, and some of them are severe. They include:

• Infections
• Blood clots
• Blockages inside the catheter tube (occlusions)
• Air embolism
• Part of the catheter slipping out of place
• Catheter tube bending, kinking or splitting
• Central vein narrowing (stenosis)
• Leaks from the central line (extravasation)
• Punctures of nearby arteries (only possible during insertion)
• Collapsed lung (only possible during insertion)

Your provider can tell you more about which risks are most likely in your case and guide you on avoiding them.

When should I call my healthcare provider?

Your healthcare provider needs to know about any changes at or around your catheter site. That includes where cuffed tunneled catheters enter your skin and where catheters with ports sit under your skin.

Some things to watch for include:

• Pain
• Skin discoloration (like redness)
• Swelling
• Fever
• Malaise
• Vomiting
• Stiffness around the catheter site
• Changes in the catheter line itself, like cracking or splitting (this is rare)
• If any part of the catheter line (or port, if you have one) shifts out of position
• Discomfort or pain when you move the arm on the catheter side, change position or cough

Your provider needs to know about these issues right away. Ask your provider what to do if any of these happen to you. Being prepared can help you avoid complications, including some that are dangerous or life-threatening.

Tunneled catheter dos and don’ts

If you have a tunneled catheter, caring for it will help you get the most out of it.

Here's what to do:

• Do wash your hands with soap and water every time before you touch the site.
• Do check the dressing (bandage) over the site every day and make sure it’s clean, dry and undamaged.
• Do get the dressing changed as recommended (healthcare providers are the only ones who should do this; you or your loved ones should never do this).
• Do cover the site as recommended whenever you shower or bathe (this can vary a little, depending on whether you have a port or cuffed catheter).

Here's what NOT to do:

• Don't pull on, pinch or tug the line.
• Don't lift anything before your provider clears you to do so.
• Don't play contact sports or do any other activities that might snag, pull or damage your tunneled catheter.
• Don't immerse the catheter in water without your provider telling you it’s safe (this only applies to tunneled catheters with ports, as regular tunneled lines should never go underwater).

Ask your provider questions if there’s some part of catheter care that you don’t understand. Your provider will answer all your questions to help you stay safe and healthy.