What are Tunneled Catheters?
Tunneled catheters are specialized central venous catheters designed for long-term use, commonly employed in pediatric patients requiring prolonged intravenous therapy. These catheters are inserted under the skin and tunneled through subcutaneous tissue before entering a central vein, typically the superior vena cava. The tunnel helps stabilize the catheter and reduce the risk of infection.
When are Tunneled Catheters Indicated?
Tunneled catheters are indicated in pediatric patients who need long-term intravenous access for various reasons including chemotherapy, total parenteral nutrition (TPN), long-term antibiotic therapy, and frequent blood draws. They are also used in children with chronic diseases like cystic fibrosis or sickle cell disease.
Types of Tunneled Catheters
There are several types of tunneled catheters, including:
1. Hickman Catheters: Commonly used for chemotherapy and blood sampling.
2. Broviac Catheters: Similar to Hickman but with a smaller lumen, suitable for younger children.
3. Groshong Catheters: Have a special valve that reduces the need for heparin flushing.Procedure for Placement
The placement of a tunneled catheter is performed in a sterile environment, often in an operating room or interventional radiology suite. The procedure typically involves:
1. Sedation or Anesthesia: To ensure the child is comfortable and pain-free.
2. Insertion: A small incision is made near the clavicle, and the catheter is tunneled under the skin and inserted into a central vein.
3. Imaging Guidance: Fluoroscopy or ultrasound may be used to ensure accurate placement.Care and Maintenance
Proper care and maintenance are crucial to prevent complications. Parents and caregivers should be educated on:
1. Flushing Protocols: Regular flushing with saline and sometimes heparin to prevent clot formation.
2. Dressing Changes: Keeping the insertion site clean and dry, with regular dressing changes as recommended by healthcare providers.
3. Monitoring for Infection: Watching for signs of infection such as redness, swelling, or discharge at the insertion site.Potential Complications
While tunneled catheters are generally safe, there are potential complications including:
1. Infection: Both local site infections and bloodstream infections can occur.
2. Catheter Occlusion: Blockages may occur, necessitating declotting procedures.
3. Mechanical Problems: Such as catheter dislodgement or breakage.Signs of Complications
Parents should be vigilant and report any of the following signs to their healthcare provider:
1. Fever or Chills: Could indicate a systemic infection.
2. Swelling or Redness: Around the catheter site.
3. Difficulty Flushing: Or drawing blood from the catheter.Removal of Tunneled Catheters
The removal of a tunneled catheter is a minor surgical procedure typically performed under local anesthesia or light sedation. The process involves:
1. Incision: To expose the catheter.
2. Disconnection and Removal: The catheter is carefully pulled out, and the site is closed with sutures or steri-strips.Parent and Caregiver Education
Education is paramount for the successful management of a tunneled catheter in a pediatric patient. Key points include:
1. Hygiene Practices: Importance of hand hygiene before handling the catheter.
2. Emergency Procedures: What to do in case the catheter becomes dislodged or if there are signs of infection.
3. Regular Follow-ups: Keeping all scheduled appointments for catheter maintenance and assessment.By understanding the indications, types, care, and potential complications of tunneled catheters, healthcare providers can ensure safe and effective use in pediatric patients, improving their quality of life and treatment outcomes.
