Q&A Tunneled vs Non-tunneled Catheters

[StephanieD]

If it is not specified, how do you know which to choose? Are there examples of each you can give me?
Thank you.

 

[Laureen]

Is this a real documentation issue - if so physician education is required.

Tunneled catheters are placed under the skin and through the subcutaneous tissue to the access site. This is usually to be left in place for longer term therapy. A tunnel is made first and then the catheter is inserted and advanced.

Non-tunneled is through a short tract which is from the skin entry site directly into the point of cannulation. It is usually more short term.

Here's a good article http://www.radiologyinfo.org/en/info.cfm?pg=vasc_access

Following are the major types of vascular access catheters:

• A peripherally inserted central catheter (PICC) is a long catheter that extends from an arm or leg vein into the largest vein (superior vena cava or inferior vena cava ) near the heart and typically provides central IV access for several weeks, but may remain in place for several months. These catheters are called "midline catheters" when they are placed in a way that the tip of the catheter remains in a relatively large vein, but doesn't extend into the largest central vein. They may have one or two lumens and some may be able to be used for CT contrast injections (manufactured for forceful contrast injections).
• A non-tunneled central catheter may be larger caliber than a PICC, and is designed to be placed via a relatively large, more central vein such as the jugular vein in the neck or the femoral vein in the groin. The skin exit point of a non-tunneled central catheter is in close proximity to the entry point of the vein used.
• A tunneled catheter may have a cuff that stimulates tissue growth that will help hold it in place in the body. Examples of the tunneled catheter include HICKMAN® catheters, BROVIAC® catheters and GROSHONG® catheters. There are several different types of dialysis catheters. The tunneled catheter is the best choice when access to the vein is needed for long period of time. It is secure and easy to access. They are more secure and usually work more efficiently than PICCs because of their larger size. The tunnel and cuff on the catheter decrease the risk of catheter infection, allowing these types to remain in place for extended periods of time. This type of catheter has portions that hang outside the skin, and is used by connecting directly to the out side ports of the catheter. The patient's skin is not directly punctured when the catheter is used. This type of catheter must be protected from getting pulled or getting wet. The skin exit point of a tunneled catheter is remote from the actual vein entry point. This tunneled path also helps reduce the risk of infection.
• A port catheter, or subcutaneous implantable port, is a permanent device that consists of a catheter attached to a small reservoir, both of which are placed under the skin similar to tunneled catheters. This catheter is placed completely under the skin. The patient's skin is punctured every time the catheter is used, but there are no restrictions on showering or bathing once the incision made for placement heals.