Tunneled Catheter Insertion

Dialysis Perm Cath and Port-a-cath for Chemotherapy

HOW SHOULD I PREPARE FOR THE PROCEDURE?

You will receive instructions from staff at the interventional radiologist's office at least a day before the procedure. Make sure to let the staff know if you have any allergies to medications or to contrast material which may be used during this procedure. If you are on any blood thinners such as Aspirin, Coumadin, Lovenox, Heparin, or Plavix please let the staff know. You may have blood drawn for pre-procedure testing at either the hospital or a local clinic. Staff will advise you if changes in your regular medication schedule are necessary. You will not be able to eat or drink after midnight the night prior to the procedure. Make sure someone will be available to drive you home afterwards.

HOW DOES THE PROCEDURE WORK?

The tunnel catheter is a permanent catheter that is fixed in place when tissue forms in response to a cuff placed beneath the skin. Typically the catheter is inserted into the internal jugular vein in the neck or the subclavian vein just below the collarbone, then tunneled from the puncture site down into the chest wall, emerging from the skin about six inches from where it entered the vein. The tip of the catheter lies in the large vein that returns blood to the heart. A tunnel catheter is the best choice when a patient is likely to need IV therapy for longer than three months and when the line will be used many times each day. It is secure and easy to access.

HOW IS THE PROCEDURE PREFORMED?

For a tunnel catheter, the physician will make two incisions usually smaller than one inch long: one over the vein where the catheter is inserted and the other where the catheter emerges from the skin. The catheter is placed beneath the skin between the two incisions. Finally, the radiologist will place two small stitches, one at each end of the tunnel, which remain in place for about one to two weeks and help keep the catheter firmly in place. A small bandage is placed over the sites and the catheter is ready to use.

WHAT WILL I EXPERIENCE DURING THE PROCEDURE?

You will lie on your back during the procedure. The local anesthetic may burn for a short time before it takes effect. You may feel some pressure or brief discomfort when the needle is placed into the vein and when the tunnel is created for the catheter. You will have to lay flat and hold your arm still for about 30 to 45 minutes during the catheter placement.

When discharged, you should rest at home for the remainder of the day and may resume your usual activities the following day, but should avoid lifting heavy objects. After having a tunnel catheter you should expect some bruising, swelling, and tenderness in the chest, neck, or shoulder, but these symptoms resolve over about five days. Pain medication may help during this time. The incisions will heal in seven to 10 days, and the stitches may be removed after that time according to your physician's instructions. For the first week, it is important to keep the catheter site clean and dry. It is important to closely follow the instructions given you about how to care for the incision and the device. You may be told that it is all right to shower after a week, using a piece of plastic wrap over the catheter insertion site, but not to swim or soak in a tub with the incision under water. Flushing the catheter at a stated interval with a heparin solution may help keep blood clots from forming and obstructing the catheter. However, instructions will vary according to the type of device used.

For 24 hours after procedure you should not drive, operate machinery, or sign any legal documents due to sedation or medication you received during the procedure.