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Insertion is a surgical procedure, in which the catheter is tunneled subcutaneously under the skin in the chest area before it enters the SVC. Commonly used tunneled catheters include Hickman, and Groshong, or Broviac catheters and may be referred to by these names as well. A tunneled catheter may remain inserted for months to years.
Groshongs may be left in place for extended periods and are used when long-term intravenous therapy is needed, such as for chemotherapy.Similar to the Hickman line, the tip of the catheter is in the superior vena cava, and the catheter is tunneled under the skin to an incision on the chest wall, where the distal end of the catheter exits the body.
The catheter is inserted into the vessel under ultrasound or fluoroscopic guidance and tunneled through the skin. Tunneled catheters have multiple channels called lumens which lay exposed on the surface of the skin. These lumens are the access points when the catheter is used. Tunneled catheters can be single, double, or triple lumened.
A Hickman line two-lumen catheter inserted on the patient's left side. Scars at the base of the neck indicate the venotomy site and insertion point into the left jugular vein . A Hickman line is a central venous catheter most often used for the administration of chemotherapy or other medications, as well as for the withdrawal of blood for analysis.
A port catheter is passed through the tunnel where one end is attached to the chemport and another end is left hanging out near the IJV insertion site. The length of the hanging port catheter should be about 16 to 17 cm (or can be measured from the IJV insertion site until 2 cm below the sternal angle where the right atrium should begin).
If a patient requires long-term dialysis therapy, a chronic dialysis catheter will be inserted. Chronic catheters contain a dacron cuff that is tunneled beneath the skin approximately 3–8 cm. The tunnel is thought to add a barrier to infection. The most popular dialysis catheter sold on the market today is the Symmetrical-Tip dialysis ...
A catheter can also be inserted into a central vein through the chest, which is known as a tunneled line. The specific type of catheter used and site of insertion are affected by the desired substance to be administered and the health of the veins in the desired site of insertion.
Most common complications with venous access are catheter related infections, thrombophlebitis and venous thrombosis. If having thrombophlebitis or thrombosis; pain when using the access is another complication. Peripheral venous access is least prone to thrombosis, followed by midline catheters and the centrally placed catheters.