Tunneled Vascular Access Catheter

Placement and removal

What is it?

A tunneled catheter is a soft tube placed in a large vein, usually in the neck, then passed under the chest skin so it exits away from the vein. A small cuff on the tube sits under the skin to hold it in place and help prevent infection. The tip rests in the large vein just above the heart.

It is used when intravenous treatment is needed for weeks or months. Some are infusion catheters for medicine, nutrition, or antibiotics. Some are dialysis catheters. It is not a PICC line, which enters a vein in the arm, and it is not a short-term neck line that is not tunneled. Removal is a separate procedure once the catheter is no longer needed.

Why do I need it?

A tunneled catheter gives reliable access to a large vein when smaller veins cannot be used for the full course of treatment. Reasons include:

Long courses of antibiotics, chemotherapy, or IV nutrition
Frequent blood draws or infusions that are hard on arm veins
Dialysis, if a fistula or graft is not ready
Removal when treatment is finished, the catheter is infected, or it is no longer working

How do I prepare?

Medicines: Tell the team about blood thinners and all other medicines. Do not stop them unless you are told to.
Allergies: Report allergies to contrast dye, numbing medicine, chlorhexidine, latex, or adhesives.
Eating and labs: If sedation is planned, you may be asked not to eat for several hours. We may check blood counts and clotting studies.
The site: Tell the team about prior neck or chest lines, a pacemaker, or skin infection on the chest or neck.
Support: Arrange a ride home. You should not drive after sedation. For removal, the cuff may need to be freed if it has been in place for more than a few weeks.

How is it placed?

You lie on your back. Monitors track your vital signs. The team cleans the neck and upper chest. Local anesthetic numbs the skin. Sedation is commonly used.
Ultrasound finds the neck vein. A needle enters the vein, a wire is passed, and live X-ray confirms the path.
A short tunnel is made under the chest skin. The catheter is pulled through the tunnel, and the cuff sits in that tunnel. The tip is positioned at the top of the right atrium.
The catheter is sutured or secured, covered with a dressing, and the neck nick is closed. Placement often takes 30 to 60 minutes.
Removal: the exit site is numbed, the cuff is freed from the tissue, and the catheter is withdrawn. Hold pressure, then apply a dressing. Do not pull it out yourself.

Care Instructions

Keep the dressing clean and dry. Change it as taught, or sooner if it is wet, loose, or soiled. Wash your hands before touching the catheter.
You may usually shower after the team says the site has sealed, often after several days. Cover the dressing. Do not soak in a bath or pool while the catheter is in place.
Do not pull, twist, or cut the catheter. Keep the clamp closed when it is not in use, if your catheter has a clamp. Flush only as you were taught.
Avoid heavy lifting and strenuous activity for a few days after placement or removal. Dialysis staff should access a dialysis catheter unless you were trained otherwise.
After removal, keep the dressing on for 24 hours. A little drainage that day can be normal. Sometimes the cuff is left on if it will not release, and the team will tell you if that happens.

What to watch out for

Call your care team promptly if you notice:

Fever, chills, or redness, swelling, or pus at the chest or neck site
The catheter slips out, the cuff becomes visible, or the line is cut or leaking
Swelling of the face, neck, or arm, or new chest pain
Bleeding that soaks the dressing, or a dressing that will not stay dry after removal
Trouble breathing, fainting, or sudden shortness of breath — seek emergency care. If the line breaks, clamp it between the break and the skin and call.