In the medical world, tunnel catheter insertion is a critical procedure widely used for patients requiring long-term access to the bloodstream. Tunnel catheters provide a reliable route for inserting medicines, chemotherapy, nutrients, and dialysis into a large vein for a prolonged period.

What is a tunnel catheter?

A tunnel catheter is a special type of central venous catheter inserted, typically in the chest area. It is called a "tunnel" catheter because it is threaded under the skin from the insertion site to the vein, with the exit point located away from the venous entry. This technique separates the actual site of the actual vein from an external entry point; hence, it is highly recommended to reduce the risk of infection for patients undergoing prolonged treatment.

The Procedure

Pre-procedure Preparation

Complete Evaluation: Scan the past medical history of the patient and the allergy profile.
Undersigned Consent: Explain the complete insertion procedure, its long-term benefits, and the risks involved for the patient, ensuring informed consent is obtained.
Correct Imaging: Correct insertion and proper placement are guided by an ultrasound or fluoroscopy.

Procedure Steps

The procedure starts with pricking your skin with a needle to locate the larger vein to insert the catheter.
The targeted area is first cleaned with an antiseptic, and local anaesthesia is injected to numb the insertion area, along with a sedative for relaxation.
The patient is then asked to be positioned with the head opposite the insertion site.
A small surgical cut is made to provide an exit to the catheter. Using a pipe or tunnel, the catheter is passed under the skin to the entry site of the selected vein.
With the help of ultrasound guidance, the vein is accessed using a needle and guidewire. The provider then threads the catheter into the vein.
When the catheter secured its place, it sutured the exit site and dressed the area with a sterile bandage.

Post-procedure Care

After the insertion procedure, it's crucial to take care of the area and provide aftercare.

Fluoroscopy or a chest x-ray confirms the catheter’s position.
A timely change of dressing to prevent infection.
Routine maintenance of the catheter involves flushing it with saline or a heparin solution to keep it free from clots.

Risks and complications

Although tunnel catheter insertion is safer for long-term access to veins, there are some potential risks and complications due to clots or sludge over time.

The infection causes redness, swelling, and discharge at the insertion site.
Severe bleeding at the insertion site.
An accidental lung puncture during insertion can result in a pneumothorax, where air enters the pleural space.
The catheter may malfunction, requiring either repositioning or replacement.
A catheter in the vein can lead to clot formation, causing venous thrombosis.

Benefits of Tunnel Catheters

The design of tunnelled catheters and the technique of distant exit sites reduce infection risks compared to non-tunnelled catheters.
Long-term use makes tunnel catheters ideal for chronic conditions requiring ongoing treatment.
Once healed, the tunnelled catheter is less likely to interfere with daily activities compared to non-tunnelled catheters.

Innovations and Future Directions

Tunnel catheter technology is getting better, with antimicrobial coatings, better materials, and advanced ways to insert them. These improvements make patients safer and more comfortable, and research into bioengineered catheters offers even more improvements.

Patient Awareness and Self-Care

For tunnel catheters to work well and safely, patients need to know how to use them. Patients should be taught many things, such as:

Notice Signs of Infection: It is important to promptly report symptoms such as swelling, rashes, redness, and fever.
Mindful Hygiene: Keeping the insertion site dry and clean, and following the complete guidelines for dressing changes, helps avoid complications.
Catheter Intensive Care: Recognise any blockages or leaks, and also understand how to flush the catheter properly.

Conclusion

Tunnel catheter insertion is a vital procedure with significant benefits for patients requiring long-term vascular access. Understanding the procedure, potential risks, and post-care instructions is essential for healthcare providers and patients alike. As medical technology advances, the safety and efficacy of tunnel catheters continue to improve, enhancing the quality of life for patients with chronic medical conditions.

Frequently Asked Questions About Tunnel Catheter Insertion

Q. What is the duration of the inserted tunnelled catheter?
A. While tunnelled catheters are advisable for prolonged treatment, they are usually used for a long time, from weeks to years.

Q. What activities should be avoided when using a tunnelled catheter?
A. Do not indulge in activities like heavy lifting and intensive exercising while the tube catheter is in place to avoid any strain or pull on the catheter.

Q. What are the different types of tunnelled catheters available?
A. Some of the commonly known tunnelled catheters are the Groshong, the Broviac, and the Hickman. The requirements of each may vary depending on the selected treatment to cure the patient's illness.

Q. Can a patient with a tube catheter shower or bathe?
A. The inserted catheter should not get drenched in water. Your healthcare provider will instruct the patient to handle the catheter while taking a bath or shower.

Q. What if the inserted catheter gets broken or dislodged?
A. Contact your healthcare provider immediately if the catheter is dislodged, damaged, or if there are any signs of malfunction. Do not try to fix it yourself.

References

https://www.ohsu.edu/sites/default/files/2019-04/Tunneled-Central-Catheter-Placement-Handout.pdf
https://www.mskcc.org/cancer-care/patient-education/about-your-tunneled-catheter