About Your Tunneled Catheter

This information explains what a tunneled catheter is and how it’s placed. It also has general guidelines for caring for your tunneled catheter at home. A tunneled catheter is a type of central venous catheter (CVC).

About Tunneled Catheters

A tunneled catheter is a flexible catheter (thin tube) that’s put into a vein in your chest. There are many different types of tunneled catheters. Your doctor will decide which type is best for you.

All tunneled catheters are tunneled under your skin and into a large vein near your heart. Outside of your body, the catheter divides into 1, 2, or 3 smaller tubes called lumens. Each lumen has a clamp, a needleless connector (also called a clave), and a disinfection cap on the end (see Figure 1).

Figure 1. Tunneled catheter

Figure 1. Tunneled catheter​​​​

A tunneled catheter can be used to:

  • Take blood samples
  • Give fluids
  • Give chemotherapy and other medications
  • Give blood transfusions
  • Give intravenous (IV) nutrition

Having a tunneled catheter can help you need fewer needle sticks. A tunneled catheter can stay in your body for as long as a few years. Your doctor will remove it when you don’t need it anymore.

Having a tunneled catheter shouldn’t keep you from doing your normal activities, such as work, school, sexual activity showering, and mild exercise. Avoid contact sports, such as football and soccer, while your catheter is in place. Ask your doctor or nurse about any activities before you start them.

You will have a procedure to place your tunneled catheter. Your nurse will tell you how to get ready for your procedure. They will also teach you how to care for your tunneled catheter after your procedure. You can have a caregiver, family member, or friend learn with you.

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Before Your Procedure

Ask about your medications

You might need to stop taking some of your medications before your procedure. Talk with your doctor about which medications are safe for you to stop taking. We have included some common examples below.

Anticoagulants (blood thinners)

If you take a blood thinner (medication that affects the way your blood clots), ask the doctor doing your procedure what to do. Their contact information is listed at the end of this resource. Whether they recommend you stop taking the medication depends on the reason you’re taking it.

Do not stop taking your blood thinner medication without talking to your doctor.

Examples of Blood Thinners
apixaban (Eliquis®) dalteparin (Fragmin®) meloxicam (Mobic®) ticagrelor (Brilinta®)
aspirin dipyridamole (Persantine®) nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil®) or naproxen (Aleve®) tinzaparin (Innohep®)
celecoxib (Celebrex®) edoxaban (Savaysa®) pentoxifylline (Trental®) warfarin (Coumadin®)
cilostazol (Pletal®) enoxaparin (Lovenox®) prasugrel (Effient®)  
clopidogrel (Plavix®) Fondaparinux (Arixtra®) rivaroxaban (Xarelto®)  
dabigatran (Pradaxa®) heparin (shot under your skin) sulfasalazine (Azulfidine®, Sulfazine®)  

Please read the resource Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs). It has important information about medications you’ll need to avoid before your procedure and what medications you can take instead.

Medications for diabetes

If you take insulin or other medications for diabetes, ask the doctor who prescribes the medication what you should do the morning of your procedure. You might need to change the dose before your procedure.

Diuretics (water pills)

If you take any diuretics (medications that make you urinate more often), ask the doctor doing your procedure what to do. You might need to stop taking them the day of your procedure. Diuretics are sometimes called water pills. Some examples are furosemide (Lasix®) and hydrochlorothiazide.

 

Arrange for someone to take you home

You must have a responsible care partner take you home after your surgery/procedure. Make sure to plan this before the day of your surgery/procedure.

If you don’t have someone to take you home, call one of the agencies below. They will send someone to go home with you. There’s usually a charge for this service, and you will need to provide transportation.

Agencies in New York                                         Agencies in New Jersey
Partners in Care: 888-735-8913                                         Caring People: 877-227-4649
Caring People: 877-227-4649                                          

Tell us if you’re sick

If you get sick (such as a fever, cold, sore throat, or the flu) before your procedure, call a nurse in Interventional Radiology at 212-639-2236. A nurse is available Monday through Friday from 9:00 am to 5:00 pm. After 5:00 pm, during the weekend, and on holidays, call 212-639-2000 and ask for the Interventional Radiology fellow on call.

Note the time of your appointment

A staff member from Interventional Radiology will call you 2 business days before your procedure. If your procedure is scheduled for a Monday, they will call you on the Thursday before.

The staff member will tell you what time you should arrive at the hospital for your procedure. They will also tell you where to go for your procedure. If you don’t get a call by noon the business day before your procedure, please call 212-639-5051.

If you need to cancel your procedure for any reason, please call the doctor who scheduled it for you.

‌  Do not eat or drink anything after midnight the night before your procedure. This includes water, gum, and hard candy.

 

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The Day of Your Procedure

Things to remember

  • Take only the medications your doctor told you to take the morning of your procedure. Take them with a few sips of water.
  • Don’t apply cream (thick moisturizers) or petroleum jelly (Vaseline®) anywhere on your chest.
  • Don’t wear eye makeup.
  • Remove any jewelry, including body piercings.
  • Leave all valuables (such as credit cards and jewelry) at home.
  • If you wear contact lenses, wear your glasses instead, if you can. If you don’t have glasses, please bring a case for your contacts.

What to bring with you

  • A list of the medications you take at home.
  • Medications for breathing problems (such as inhalers), if you take any.
  • Medications for chest pain, if you take any.
  • A case for your glasses or contacts.
  • Your Health Care Proxy form and other advance directives, if you have completed them.
  • If you use a CPAP or BiPAP machine to sleep at night, bring your machine with you, if you can. If you can’t bring your machine with you, we will give you one to use while you’re in the hospital.

What to expect

Once you arrive at the hospital, doctors, nurses, and other staff members will ask you to say and spell your name and date of birth many times. This is for your safety. People with the same or a similar name might be having a procedure on the same day.

 
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During Your Procedure

First, you will get a numbing injection (shot) at the base of your neck and on your chest under your collarbone. Once the areas are numb, your doctor will make small incisions (surgical cuts). They will place the catheter through the incision on your chest and tunnel it under your skin to the incision at the base of your neck. Then, they will thread the catheter into your vein (see Figure 2). They will use an imaging scan to help them see the catheter while they do this.

Figure 2. Catheter tunneled under your skin, into a vein

Figure 2. Catheter tunneled under your skin, into a vein

Once the catheter is in your vein, your doctor will use Steri-Strips™ (surgical tape) to close the incision at the base of your neck. They will stitch your catheter to your skin at the place where it leaves your body (the exit site). This will keep the catheter in place.

At the end of your procedure, your doctor will put a gauze dressing (bandage) over the incision on your neck and a Tegaderm™ dressing over your catheter exit site.

 
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After Your Procedure

After your procedure, you will be brought to the recovery room. You will stay in the recovery room until you’re ready to move to your hospital room or be discharged from (leave) the hospital.

You might have some bleeding and mild discomfort at your catheter exit side. This can last for about 1 to 3 days after your catheter is placed. If you have any bleeding from your exit site, apply pressure and a cold compress to the area. Call your doctor or nurse if the bleeding and discomfort gets worse at any time.

Don’t shower for 24 hours after your procedure.

Your emergency kit

Your nurse will give you an emergency kit before your procedure or before you’re discharged from the hospital. The emergency kit has:

  • 1 toothless clamp
  • 1 dressing change kit. The kit includes:
    • 2 face masks
    • Alcohol-based (Purell®) hand wipe
    • Disposable drape
    • 2 pairs of nitrile gloves (sterile gloves)
    • Chloroprep® applicator
    • Alcohol pads
    • No Sting swab stick
    • 3 needless connectors
    • Tegaderm CHG dressing
  • Disinfection caps
  • Your doctor’s office and emergency telephone numbers.

Keep your emergency kit with you at all times. You will need it if your catheter is leaking, your Tegaderm dressing is damaged or comes off, or your needleless connector or disinfection cap falls off.

Your catheter exit site

You might need to have your Tegaderm dressing changed within 48 hours (2 days) of your procedure. Your doctor or nurse will tell you if you do.

You should always have a Tegaderm dressing over your exit site while your tunneled catheter is in place. The Tegaderm dressing helps prevent infection.

Your neck incision

Two days after your procedure, you can remove the gauze bandage over the small incision on your neck. You don’t need to put a new bandage over the incision.

Leave the Steri-Strips in place until they start to peel off. This should happen about 3 to 5 days after your procedure.

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Caring for Your Tunneled Catheter at Home

  • Clamp the lumens when your catheter isn’t in use.
  • Keep your catheter secure at all times to keep from pulling it. Ask your nurse about the best way to secure your catheter. You can tape the lumens to your skin, tuck them into your bra, or wrap them in medical tape and pin the tape to your clothing. Don’t put tape over the connection site (where the needleless connector connects to the lumens).
  • Check your exit site every day for:
    • Redness
    • Tenderness
    • Leakage
    • Swelling
    • Bleeding
    If you have any of these signs or symptoms, call your doctor. You might have an infection.
  • Your Tegaderm dressing, needleless connectors, and disinfection caps will need to be changed and your catheter will need to be flushed at least once a week. It’s best if you can come to a Memorial Sloan Kettering (MSK) location so a nurse can do these things. If you can’t come to an MSK site, your nurse will help you make other arrangements. Always contact your doctor or nurse if you have any questions.

What to do if your catheter is leaking

  1. Clamp your catheter above the leak.
    • Move the white clamp on the catheter so it’s above the leak, if you can.
    • If you can’t use the white clamp, use the clamp in your emergency kit.
  2. Wipe the area that’s leaking with an alcohol pad.
  3. Call your doctor’s office right away.

What to do if your Tegaderm dressing is damaged, loose, or dirty

  1. Don’t take off the damaged, loose, or dirty dressing. Put a new Tegaderm dressing over it.
  2. Call your doctor’s office right away.

What to do if your Tegaderm dressing is wet

  1. Don’t take off the wet Tegaderm dressing. Don’t put another dressing over it.
  2. Call your doctor’s office right away.

What to do if your disinfection cap falls off

Throw the disinfection cap that fell off in the trash. Don’t put it back on the lumen.

To put on a new disinfection cap:

  1. Clean your hands with soap and water or an alcohol-based hand sanitizer.
  2. Get a new disinfection cap from your emergency kit. Remove the cap from the strip.
  3. Hold the needleless connector in one hand. With your other hand, gently push and twist the new disinfection cap onto the end of the needleless connector.

What to do if your needleless connector falls off

Throw the needleless connector that fell off in the trash. Don’t put it back on the lumen.

To put on a new needleless connector:

  1. Gather your supplies. You will need:
    • 1 pair of nonsterile gloves
    • 2 alcohol pads
    • 1 new needleless connector
    • 1 new disinfection cap
  2. Clean your hands with soap and water or an alcohol-based hand sanitizer. Put the gloves on.
  3. Get your supplies ready.
    • Open 1 of the alcohol pad packets, but leave the alcohol pad inside.
    • Open the needleless connector packet, but leave the needleless connector inside.
    • Pull the tab to take the cover off the disinfection cap, but leave the disinfection cap inside its plastic holder.
  4. Open the other alcohol pad packet. Using the alcohol pad inside, pick up the lumen with your nondominant hand (the hand you don’t write with). Hold it close to the end (see Figure 3).
  5. Pick up the other, open alcohol pad with your dominant hand (the hand you write with). Scrub the open end of the lumen with the alcohol pad for 15 seconds, then throw the alcohol pad in the trash. Let the lumen dry for 15 seconds. Keep holding it with the alcohol pad in your nondominant hand.
  6. Pick up the new needleless connector with your free hand. If it has a cover, take the cover off. You can do this using the knuckles of your other hand. Then, twist the new needleless connector onto the end of the lumen (see Figure 3). Keep holding the lumen with the alcohol pad in your nondominant hand.
    Figure 3.Twisting on the new needleless connector

    Figure 3. Twisting on the new needleless connector

  7. Pick up the plastic holder with the disinfection cap with your free hand. Gently push and twist the disinfection cap onto the end of the needleless connector. Once it’s attached, pull off the plastic holder and throw it away.
  8. Take your gloves off. Clean your hands.

Call your doctor or nurse after you change the needleless connector.

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Guidelines for Showering

Follow the instructions in this section when you shower. Don’t submerge your catheter in water (such as in a bathtub or swimming pool).

For more information about showering with a tunneled catheter, watch Showering While You Have a Central Venous Catheter (CVC).

Use a waterproof cover

You can shower with your catheter in place using a one-time-use waterproof cover that goes over your dressing (such as Aquaguard®). You can buy waterproof covers online.

Each time you shower, cover your Tegaderm dressing completely with a new waterproof cover to keep it from getting wet. To put on the waterproof cover:

  1. Peel off the top and side strips.
  2. Place the top edge above your dressing. Don’t let the tape on the waterproof cover touch your Tegaderm dressing. It can lift your dressing when you remove the waterproof cover after showering. Smooth the cover down over your dressing.
  3. Peel off the bottom strip. Make sure the bottom edge of the waterproof cover is below your dressing and the lumens of your catheter are tucked into the waterproof cover and completely covered. Smooth the bottom edge down.

Don’t shower for longer than 15 minutes. Use warm water, not hot water. This will help keep the waterproof cover from coming off.

After your shower, dry the waterproof cover before you take it off.

Use Hibiclens® skin cleanser

While your tunneled catheter is in place, it’s very important to keep your skin clean to lower your risk of infection. Wash with Hibiclens every day while your tunneled catheter is in place.

Hibiclens is a skin cleanser that kills germs for up to 24 hours after you use it. It has a strong antiseptic (liquid used to kill germs and bacteria) called chlorhexidine gluconate (CHG). Showering with Hibiclens will help lower your risk of infection.

You can buy Hibiclens from any local pharmacy or online. You will be sent home with a small bottle when you’re discharged from the hospital.

Instructions for using Hibiclens

  1. Use your normal shampoo to wash your hair. Rinse your head well.
  2. Use your normal soap to wash your face and genital area. Rinse your body well with warm water.
  3. Open the Hibiclens bottle. Pour some solution into your hand or a clean washcloth.
  4. Move away from the shower stream to avoid rinsing off the Hibiclens too soon.
  5. Rub the Hibiclens gently over your body from your neck to your feet. Don’t put the Hibiclens on your face or genital area.
  6. Move back into the shower stream to rinse off the Hibiclens with warm water.
  7. Dry yourself off with a clean towel after your shower.
  8. Don’t put on any lotion, cream, deodorant, makeup, powder, or perfume after your shower.

Important points to remember when using Hibiclens

  • Don’t use regular soap, lotion, cream, powder, or deodorant without talking with your nurse first. If you’re in the hospital, your nurse might give you a lotion that you can use after using Hibiclens.
  • Don’t use Hibiclens on your head, face, ears, eyes, mouth, genital area, or on deep wounds. If you have a wound and aren’t sure if you should use Hibiclens on it, ask your doctor or nurse.
  • Don’t use Hibiclens if you’re allergic to chlorhexidine.
  • If your skin gets irritated or you have an allergic reaction when using Hibiclens, stop using it and call your doctor.
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Call Your Doctor or Nurse Right Away If:

  • Your dressing is damaged, dirty, or peeling off.
  • Your dressing gets wet.
  • You have redness, swelling, or drainage around your catheter exit site.
  • Your needleless connector falls off.
  • You have a fever of 100.4 °F (38 °C) or higher or chills.
  • You have a break or leak in your catheter.
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