A Tunneled Catheter is a tube that is inserted beneath the skin of the upper chest and courses over the collar bone to enter into a large neck vein called the internal jugular vein at the base of the neck. The catheter is then positioned so the end of the catheter is in the largest vein in the chest called the superior vena cava. The Tunneled Catheter can be used to give you treatments such as chemotherapy, antibiotics, intravenous fluids or feedings. Blood samples can be drawn from the PICC line if blood testing is required. Most Tunneled Catheters have several hubs or connections on the part of the catheter outside the body so several different medications can be given at the same time through the catheter. The Tunneled catheter allows you to have your intravenous treatments without having needles frequently inserted into your veins. This may be particularly helpful if your veins are hard to find or have been hardened by previous chemotherapy treatment.
How is a Tunneled Catheter put in?
Your Tunneled Catheter will be put in by a Surgeon or Interventional Radiologist. Tunneled Catheters are typically put in using local anesthesia and relaxing or 'twilight' sedative medications. You will have a small needle put into a vein in your arm or hand and you will be given medicine to help you to relax. The doctor will inject a local anesthetic into your skin to numb a couple of small areas on your chest and neck. After this you may be aware of activity around you and may feel some pressure on your chest (or arm) during the procedure, but you should not feel any pain.
You will have one or two small incisions (cuts in your skin). The first incision will be about 1-3 cm long on your upper chest and is where tunneled catheter is placed. There will be a smaller incision at the base of the neck, just above the collarbone, which is usually less than 1--2 cm (½--1 in) long. The catheter will be tunneled under the skin from the lower chest incision to the incision above. One end of the catheter is then placed into a neck vein and the other end will exit the skin of the upper chest. The tunneled catheter is then secured in place, typically with stitches.
You may also have a chest x-ray to make sure the port is in the right place.
A small dressing may be used to cover the wounds for a day or so after the procedure. The nursing team will teach you how to look after this.
You may feel a bit sore and bruised for a few days after the port is put in. A mild painkiller such as acetaminophen will help with this.
Immediately after the port has been put in, and for a few days afterwards, check for any redness, swelling, bleeding, bruising, pain or heat around the wounds. Let your doctor know immediately if you have any of these signs as you could have an infection, which may need to be treated.
Care of your tunneled catheter
After each treatment a small amount of fluid is 'flushed' into the catheter so that it does not become blocked. The dressing will also need to be changed regularly to reduce the risk of infection.
Possible Problems
Infection
Any time a medical device, like a tunneled catheter, passes through the skin it is possible for an infection to develop inside or around the device. Because the tunneled catheter enters into a vein it is possible for the infection to spread into the bloodstream. If the area where the tunneled catheter enters the body becomes red, swollen, tender or oozes you should tell doctor immediately. If you have a tunneled catheter and develop a fever or if you feel faint, shivery, breathless or dizzy you should tell your doctor immediately as this may be a sign of a catheter or bloodstream infection. To treat the infection you may be given antibiotics or the tunneled catheter may need to be removed.
Clots
It is possible for a clot (thrombosis) to form in or on the catheter. If enough clot forms around the tunneled catheter the vein in which the tunneled catheter was placed may become blocked or damaged. If this happens, the tunneled catheter may have to be removed. You may be given some medication to help dissolve clots in or around the catheter. Signs of a clot include swelling, tenderness or redness in the arm, neck or face on the same side of the body as the tunneled catheter line.
Damage or Inadvertent Removal of the Tunneled Catheter
Tunneled catheters are typically stitched in place to prevent accidental removal. Tunneled catheters also have a special ring or cuff of material around the catheter that promotes adherence of the catheter to the surrounding tissues that also helps prevent accidental removal. However, it is important to be careful with your tunneled catheter to make sure that it is not damaged or pulled out accidentally.
If the tunneled catheter line becomes damaged or torn contact your doctor.
If the tunneled catheter becomes accidentally removed there may be some bleeding from the site where the tunneled catheter enters the skin. To stop any bleeding sit or stand up and hold firm pressure with the palm of your hand on the chest between the place the catheter enters the skin and the collarbone for 5-10 minutes. If there is severe bleeding or the bleeding does not stop seek medical attention immediately.
If the tunneled catheter has been pulled back but has not been pulled completely out secure the catheter in place and call your doctor to arrange for replacement or repositioning.
How is the tunneled catheter removed?
Your doctor will use a local anesthetic to numb the skin where the catheter enters the skin of the chest. The catheter will be freed from the surrounding tissues and gently pulled out. The doctor or assistant will hold pressure over the upper chest and base of the neck for a few minutes to control any bleeding. A stitch or some skin glue may be applied to close the wound and a dressing will be applied. Your doctor will give you instructions on how to care for the wound until it is fully healed.
