Name of the Procedure:

Insertion of Tunneled Centrally Inserted Central Venous Catheter (also known as a Central Line), without Subcutaneous Port or Pump; Age 5 Years or Older

Summary

This is a medical procedure where a long, thin tube (catheter) is placed into a large vein in the chest. The catheter is tunneled under the skin and then inserted into a large vein near the heart. This procedure does not involve attaching a subcutaneous port or pump.

Purpose

The procedure is performed to provide long-term access to a large vein for the administration of medications, nutrition, or fluids, and for the collection of blood samples. It is often used in patients who require frequent or ongoing medical treatments such as chemotherapy, long-term antibiotics, or total parenteral nutrition.

Indications

• Need for long-term intravenous access
• Frequent blood draws
• Chemotherapy
• Total parenteral nutrition
• Long-term administration of antibiotics or other medications

Preparation

• Fasting may be required for several hours before the procedure.
• Medication adjustments, especially blood thinners, may be necessary.
• Blood tests and imaging (such as ultrasound or X-ray) may be performed to assess veins and overall health.

Procedure Description

1. Preparation: The patient lies on their back. The skin area where the catheter will be inserted is cleaned and sterilized.
2. Anesthesia: Local anesthesia is administered to numb the area. Sedation or general anesthesia may be used, particularly in younger patients.
3. Insertion: A small incision is made near the collarbone (clavicle). A tunnel is created under the skin from the incision site to the chest area where the vein is located. The catheter is then threaded through the tunnel and inserted into the vein.
4. Positioning: The catheter tip is positioned near the heart (specifically, the superior vena cava).
5. Securing: The catheter is secured in place using sutures or a securement device and covered with a sterile dressing.
6. Verification: The placement of the catheter is verified using imaging, typically X-ray.

Duration

The procedure typically takes between 1 to 2 hours.

Setting

The procedure is usually performed in an operating room, interventional radiology suite, or a specialized outpatient surgical center.

Personnel

• Interventional Radiologist or Surgeon
• Nurses
• Anesthesiologist (if applicable)
• Radiology Technician (if imaging is used)

Risks and Complications

• Infection
• Bleeding or bruising
• Damage to surrounding tissues or organs
• Pneumothorax (collapsed lung)
• Catheter malfunction or displacement
• Blood clots

Benefits

• Reliable and long-term venous access
• Reduced need for multiple needle sticks
• Easier administration of treatments and medications
• Facilitation of frequent blood sampling

Recovery

• Immediate post-procedure monitoring for a few hours.
• Instructions to keep the catheter site clean and dry.
• Avoid heavy lifting and strenuous activity for a few days.
• Follow-up appointment to check catheter placement and site healing.

Alternatives

• Peripheral IV catheter: Suitable for short-term use but needs frequent replacement.
• Peripherally Inserted Central Catheter (PICC): Less invasive but not ideal for long-term use.
• Implanted Port: Involves surgery and is less visible but more complex to access.

Patient Experience

• The patient may feel pressure or mild discomfort during insertion but should not feel pain due to anesthesia.
• Post-procedure, there may be some soreness at the insertion site.
• Pain management can include over-the-counter pain medications.
• Detailed care instructions will be provided to manage the catheter at home.