TUNNELED CATHETERS

Dr Prashant Jain
Sr Consultant Ped. Surgery
BLK Superspeciality Hospital, New Delhi
 What is tunneled catheter?

 Processed silicone

 A tunneled central line is a

catheter (a thin tube) that is
placed in a vein for long-term
use

 It is most commonly placed in

the internal jugular or
subclavian vein

.
T
U
N
N
E
L
 Purpose

Long term infusions and chemotherapy for

longer than 3 weeks

 Chemotherapy and bone marrow transplant

(BMT)
 Plasmapheresis and leukapheresis
 Hemodialysis
 Total parenteral nutrition (TPN)
 Parts
 It has a cuff
Antimicrobial cuff
Allows tissue and skin to grow
around it

 Keeps it more stable and infection free

CLAMP

CONNECTORS CUFF
 Types

 Hickman catheter

 Broviac Catheter

 Groshong Catheter
 Hickman Catheter

• Single, Dual and Triple Lumen

• Range from 2.7 FR- 12.5 FR
• Repairable
• Easy to handle
 What is the advantage?

Product Dwell Time

 Secured for long time Tunneled 1-6 months
CVC
 No repeated Poking
 Reduces the discomfort Non- 3-6 weeks
Tunneled
CVC
 Selection

 Purpose

 One size does NOT fit all

 Number of lumens
 Contraindications

 Deranged coagulation
 Sepsis
 Local Infection
 Allergy
 Preparation

 Anesthesia: GA/LA
 No antibiotics
 Informed consent
 Position
 Rt IJV is preferred
 Sterility is MANDATARY
 Equipment

ULTRASOUND C-ARM
Catheter Trolley
A
V
Chemoport
Retrospective study @BLK

Total patients:
VAD
126

14
44
Male Hickman
112 catheter
Female
Chemoport
82
 Indications

Benign
hematological  Duration of study :37
disorder months
15
 Mean duration of
Hematological
31 malignancies catheter in situ: 116.13
80
days
 Median catheter
Solid tumors
days:180 days
 Minimum age:5months
 Maximum age:18 yrs
 Procedure

 Right internal jugular

vein
 101 patients had
double lumen
catheter
 11 patients had single
lumen catheter
Ultrasound and Fluoroscopic guidance
 Overall complications: 13/126
Intraoperative 2
Hematoma formation 1

Supraventricular Tachycardia 1

Premature removal 11
Accidental removal 1

Transmigration of catheter into right 1

pulmonary artery
Catheter misplacement 2

Catheter blockage 1

Fracture of catheter 2
Infection 4
 Conclusion
 Complication rates are less than/comparable to the studies
reported in literature showing rates of premature removal
between 10% to 30.2% (Our study:10.3%).
 Catheter related infections were common cause of premature
removal in our study, which occurred in 3.17 %
 USG & flouroscopic guidance reduces:
-Primary catheter malposition
-Successful insertion at the first attempt
-Optimum catheter tip position
-Reduces mechanical occlusion
 Complications like pneumothorax, accidental arterial
perforation ,vascular erosion, catheter compression are
markedly reduced due to USG guidance -0%(our study)