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Catheters, Nontunneled and Tunneled
Anatoly Loskutov, MD; Brandt C. Wible, MD
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KEY FACTS

  • Terminology

    • Procedure

      • Post Procedure

        • Outcomes

          TERMINOLOGY

          • Synonyms

            • Nontunneled catheters
              • Temporary central venous catheter
              • Temporary dialysis catheter
              • Central venous catheter
            • Tunneled catheters
              • Tunneled hemodialysis (HD) catheter
              • Tunneled central venous catheter
              • Permanent catheter
          • Definitions

            • Nontunneled catheter: Short-term central venous catheter placed percutaneously into central veins of chest or abdomen
              • Catheter of choice in management of acute medical conditions
              • Typical dwell time of days to weeks
              • Not appropriate for outpatient setting
            • Tunneled catheter: Intermediate- or long-term venous catheter introduced through subcutaneous tunnel into central veins of chest or abdomen
              • Subcutaneous tunnel forms natural infection barrier
              • Dacron cuff on catheter promotes tissue ingrowth
                • Secures catheter within tunnel
                • Enhances natural infection barrier of tunnel
              • Various tunneled catheters for range of indications
                • HD catheter
                • Pheresis catheter
                • Tunneled central venous catheter
                  • Hickman catheter
                  • Broviac catheter
                  • Groshong catheter
            • Types of catheters
              • End-hole catheter
                • Most common type of catheter
                • Tip may be trimmed to required length
                • Typical use for tunneled central venous catheters
              • Staggered-tip catheter
                • Designed to allow simultaneous aspiration/infusion with minimal mixing
                • Cannot trim tip
                • Typical use is for temporary HD or plasmapheresis
              • Valve-tip catheter
                • Valve opens inward for aspiration/outward for infusion
                • Cannot trim tip
                • Adaptor allows external portion of catheter to be trimmed to appropriate length

          PREPROCEDURE

          • Indications

            • Contraindications

              • Preprocedure Imaging

                • Getting Started

                  PROCEDURE

                  • Patient Position/Location

                    • Procedure Steps

                      • Alternative Procedures/Therapies

                        POST PROCEDURE

                        • Expected Outcome

                          • Things to Do

                            • Things to Avoid

                              • Management of Nontunneled Catheter-Specific Complications

                                • Management of Impaired Tunneled Catheters

                                  OUTCOMES

                                  • Complications

                                    • Expected Outcomes

                                      Selected References

                                      1. Forneris G et al: Ultrasound in central venous access for hemodialysis. J Vasc Access. 22(1_suppl):97-105, 2021
                                      2. Agarwal AK et al: Avoiding problems in tunneled dialysis catheter placement. Semin Dial. 32(6):535-40, 2019
                                      3. Ibeas-Lopez J: New technology: heparin and antimicrobial-coated catheters. J Vasc Access. 16 Suppl 9:S48-53, 2015
                                      4. Clark EG et al: Temporary hemodialysis catheters: recent advances. Kidney Int. 86(5):888-95, 2014
                                      5. Hacker RI et al: Fibrin sheath angioplasty: a technique to prevent superior vena cava stenosis secondary to dialysis catheters. Int J Angiol. 21(3):129-34, 2012
                                      6. Patel IJ et al: Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol. 23(6):727-36, 2012
                                      7. Vats HS: Complications of catheters: tunneled and nontunneled. Adv Chronic Kidney Dis. 19(3):188-94, 2012
                                      8. Bhutta ST et al: Evaluation and management of central venous access complications. Tech Vasc Interv Radiol. 14(4):217-24, 2011
                                      9. Chung HY et al: Principles of non-tunneled central venous access. Tech Vasc Interv Radiol. 14(4):186-91, 2011
                                      10. Heberlein W: Principles of tunneled cuffed catheter placement. Tech Vasc Interv Radiol. 14(4):192-7, 2011
                                      11. Ni N et al: Association between disruption of fibrin sheaths using percutaneous transluminal angioplasty balloons and late onset of central venous stenosis. Cardiovasc Intervent Radiol. 34(1):114-9, 2011
                                      12. Haas B et al: Large-bore tunneled central venous catheter insertion in patients with coagulopathy. J Vasc Interv Radiol. 21(2):212-7, 2010
                                      13. Nakae H et al: Catheter-related infections via temporary vascular access catheters: a randomized prospective study. Artif Organs. 34(3):E72-6, 2010
                                      14. Vanholder R et al: Catheter-related blood stream infections (CRBSI): a European view. Nephrol Dial Transplant. 25(6):1753-6, 2010
                                      15. Banerjee S: Dialysis catheters and their common complications: an update. ScientificWorldJournal. 9:1294-9, 2009
                                      16. Chan MR et al: Tunneled dialysis catheters: recent trends and future directions. Adv Chronic Kidney Dis. 16(5):386-95, 2009
                                      17. Coryell L et al: The case for primary placement of tunneled hemodialysis catheters in acute kidney injury. J Vasc Interv Radiol. 20(12):1578-81; quiz 1582, 2009
                                      18. Pittiruti M et al: ESPEN guidelines on parenteral nutrition: central venous catheters (access, care, diagnosis and therapy of complications). Clin Nutr. 28(4):365-77, 2009
                                      19. Worth LJ et al: Infective and thrombotic complications of central venous catheters in patients with hematological malignancy: prospective evaluation of nontunneled devices. Support Care Cancer. 17(7):811-8, 2009
                                      20. Ash SR: Advances in tunneled central venous catheters for dialysis: design and performance. Semin Dial. 21(6):504-15, 2008
                                      21. Ausserhofer D et al: [Care of the non-tunneled central venous catheter. Literature search on disinfectants, dressings and intervals between dressing changes.] Pflege Z. 61(8):457-62, 2008
                                      22. Hwang FR et al: Tunneled infusion catheter breakage: frequency and repair kit outcomes. J Vasc Interv Radiol. 19(2 Pt 1):201-6, 2008
                                      23. Siegel JB: Tunneled dialysis catheters: pearls and pitfalls. Tech Vasc Interv Radiol. 11(3):181-5, 2008
                                      24. Ward E et al: Tunneled central venous catheter malpositioning. Cardiovasc Intervent Radiol. 31(3):673, 2008
                                      25. Castelli GP et al: Central venous catheter replacement in the ICU: new site versus guidewire exchange. Minerva Anestesiol. 73(5):267-73, 2007
                                      26. Toro JJ et al: Patterns of use of vascular access devices in patients undergoing hematopoietic stem cell transplantation: results of an international survey. Support Care Cancer. 15(12):1375-83, 2007
                                      27. Chiou PF et al: Antibiotic lock technique reduces the incidence of temporary catheter-related infections. Clin Nephrol. 65(6):419-22, 2006
                                      28. Maki DG et al: The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc. 81(9):1159-71, 2006
                                      29. Warren DK et al: A multicenter intervention to prevent catheter-associated bloodstream infections. Infect Control Hosp Epidemiol. 27(7):662-9, 2006
                                      30. Ponikvar R et al: Temporary hemodialysis catheters as a long-term vascular access in chronic hemodialysis patients. Ther Apher Dial. 9(3):250-3, 2005
                                      31. Abdelkefi A et al: [Infectious complications related to non-tunneled central venous catheters in immunocompromised patients: prospective study about 210 cases.] Ann Fr Anesth Reanim. 22(9):773-7, 2003
                                      32. Crowley JJ: Vascular access. Tech Vasc Interv Radiol. 6(4):176-81, 2003
                                      33. Lewis CA et al: Quality improvement guidelines for central venous access. J Vasc Interv Radiol. 14(9 Pt 2):S231-5, 2003
                                      34. III. NKF-K/DOQI clinical practice guidelines for vascular access: update 2000. Am J Kidney Dis. 37(1 Suppl 1):S137-81, 2001
                                      35. Cicconi S et al: Non-tunneled central venous catheters in adult stem cell transplantation recipients: an effective option. J Vasc Access. 2(4):168-74, 2001
                                      36. Abidi SM et al: Factors influencing function of temporary dialysis catheters. Clin Nephrol. 53(3):199-205, 2000
                                      37. Oliver MJ et al: Risk of bacteremia from temporary hemodialysis catheters by site of insertion and duration of use: a prospective study. Kidney Int. 58(6):2543-5, 2000
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Procedure

                                          • Post Procedure

                                            • Outcomes

                                              TERMINOLOGY

                                              • Synonyms

                                                • Nontunneled catheters
                                                  • Temporary central venous catheter
                                                  • Temporary dialysis catheter
                                                  • Central venous catheter
                                                • Tunneled catheters
                                                  • Tunneled hemodialysis (HD) catheter
                                                  • Tunneled central venous catheter
                                                  • Permanent catheter
                                              • Definitions

                                                • Nontunneled catheter: Short-term central venous catheter placed percutaneously into central veins of chest or abdomen
                                                  • Catheter of choice in management of acute medical conditions
                                                  • Typical dwell time of days to weeks
                                                  • Not appropriate for outpatient setting
                                                • Tunneled catheter: Intermediate- or long-term venous catheter introduced through subcutaneous tunnel into central veins of chest or abdomen
                                                  • Subcutaneous tunnel forms natural infection barrier
                                                  • Dacron cuff on catheter promotes tissue ingrowth
                                                    • Secures catheter within tunnel
                                                    • Enhances natural infection barrier of tunnel
                                                  • Various tunneled catheters for range of indications
                                                    • HD catheter
                                                    • Pheresis catheter
                                                    • Tunneled central venous catheter
                                                      • Hickman catheter
                                                      • Broviac catheter
                                                      • Groshong catheter
                                                • Types of catheters
                                                  • End-hole catheter
                                                    • Most common type of catheter
                                                    • Tip may be trimmed to required length
                                                    • Typical use for tunneled central venous catheters
                                                  • Staggered-tip catheter
                                                    • Designed to allow simultaneous aspiration/infusion with minimal mixing
                                                    • Cannot trim tip
                                                    • Typical use is for temporary HD or plasmapheresis
                                                  • Valve-tip catheter
                                                    • Valve opens inward for aspiration/outward for infusion
                                                    • Cannot trim tip
                                                    • Adaptor allows external portion of catheter to be trimmed to appropriate length

                                              PREPROCEDURE

                                              • Indications

                                                • Contraindications

                                                  • Preprocedure Imaging

                                                    • Getting Started

                                                      PROCEDURE

                                                      • Patient Position/Location

                                                        • Procedure Steps

                                                          • Alternative Procedures/Therapies

                                                            POST PROCEDURE

                                                            • Expected Outcome

                                                              • Things to Do

                                                                • Things to Avoid

                                                                  • Management of Nontunneled Catheter-Specific Complications

                                                                    • Management of Impaired Tunneled Catheters

                                                                      OUTCOMES

                                                                      • Complications

                                                                        • Expected Outcomes

                                                                          Selected References

                                                                          1. Forneris G et al: Ultrasound in central venous access for hemodialysis. J Vasc Access. 22(1_suppl):97-105, 2021
                                                                          2. Agarwal AK et al: Avoiding problems in tunneled dialysis catheter placement. Semin Dial. 32(6):535-40, 2019
                                                                          3. Ibeas-Lopez J: New technology: heparin and antimicrobial-coated catheters. J Vasc Access. 16 Suppl 9:S48-53, 2015
                                                                          4. Clark EG et al: Temporary hemodialysis catheters: recent advances. Kidney Int. 86(5):888-95, 2014
                                                                          5. Hacker RI et al: Fibrin sheath angioplasty: a technique to prevent superior vena cava stenosis secondary to dialysis catheters. Int J Angiol. 21(3):129-34, 2012
                                                                          6. Patel IJ et al: Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol. 23(6):727-36, 2012
                                                                          7. Vats HS: Complications of catheters: tunneled and nontunneled. Adv Chronic Kidney Dis. 19(3):188-94, 2012
                                                                          8. Bhutta ST et al: Evaluation and management of central venous access complications. Tech Vasc Interv Radiol. 14(4):217-24, 2011
                                                                          9. Chung HY et al: Principles of non-tunneled central venous access. Tech Vasc Interv Radiol. 14(4):186-91, 2011
                                                                          10. Heberlein W: Principles of tunneled cuffed catheter placement. Tech Vasc Interv Radiol. 14(4):192-7, 2011
                                                                          11. Ni N et al: Association between disruption of fibrin sheaths using percutaneous transluminal angioplasty balloons and late onset of central venous stenosis. Cardiovasc Intervent Radiol. 34(1):114-9, 2011
                                                                          12. Haas B et al: Large-bore tunneled central venous catheter insertion in patients with coagulopathy. J Vasc Interv Radiol. 21(2):212-7, 2010
                                                                          13. Nakae H et al: Catheter-related infections via temporary vascular access catheters: a randomized prospective study. Artif Organs. 34(3):E72-6, 2010
                                                                          14. Vanholder R et al: Catheter-related blood stream infections (CRBSI): a European view. Nephrol Dial Transplant. 25(6):1753-6, 2010
                                                                          15. Banerjee S: Dialysis catheters and their common complications: an update. ScientificWorldJournal. 9:1294-9, 2009
                                                                          16. Chan MR et al: Tunneled dialysis catheters: recent trends and future directions. Adv Chronic Kidney Dis. 16(5):386-95, 2009
                                                                          17. Coryell L et al: The case for primary placement of tunneled hemodialysis catheters in acute kidney injury. J Vasc Interv Radiol. 20(12):1578-81; quiz 1582, 2009
                                                                          18. Pittiruti M et al: ESPEN guidelines on parenteral nutrition: central venous catheters (access, care, diagnosis and therapy of complications). Clin Nutr. 28(4):365-77, 2009
                                                                          19. Worth LJ et al: Infective and thrombotic complications of central venous catheters in patients with hematological malignancy: prospective evaluation of nontunneled devices. Support Care Cancer. 17(7):811-8, 2009
                                                                          20. Ash SR: Advances in tunneled central venous catheters for dialysis: design and performance. Semin Dial. 21(6):504-15, 2008
                                                                          21. Ausserhofer D et al: [Care of the non-tunneled central venous catheter. Literature search on disinfectants, dressings and intervals between dressing changes.] Pflege Z. 61(8):457-62, 2008
                                                                          22. Hwang FR et al: Tunneled infusion catheter breakage: frequency and repair kit outcomes. J Vasc Interv Radiol. 19(2 Pt 1):201-6, 2008
                                                                          23. Siegel JB: Tunneled dialysis catheters: pearls and pitfalls. Tech Vasc Interv Radiol. 11(3):181-5, 2008
                                                                          24. Ward E et al: Tunneled central venous catheter malpositioning. Cardiovasc Intervent Radiol. 31(3):673, 2008
                                                                          25. Castelli GP et al: Central venous catheter replacement in the ICU: new site versus guidewire exchange. Minerva Anestesiol. 73(5):267-73, 2007
                                                                          26. Toro JJ et al: Patterns of use of vascular access devices in patients undergoing hematopoietic stem cell transplantation: results of an international survey. Support Care Cancer. 15(12):1375-83, 2007
                                                                          27. Chiou PF et al: Antibiotic lock technique reduces the incidence of temporary catheter-related infections. Clin Nephrol. 65(6):419-22, 2006
                                                                          28. Maki DG et al: The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc. 81(9):1159-71, 2006
                                                                          29. Warren DK et al: A multicenter intervention to prevent catheter-associated bloodstream infections. Infect Control Hosp Epidemiol. 27(7):662-9, 2006
                                                                          30. Ponikvar R et al: Temporary hemodialysis catheters as a long-term vascular access in chronic hemodialysis patients. Ther Apher Dial. 9(3):250-3, 2005
                                                                          31. Abdelkefi A et al: [Infectious complications related to non-tunneled central venous catheters in immunocompromised patients: prospective study about 210 cases.] Ann Fr Anesth Reanim. 22(9):773-7, 2003
                                                                          32. Crowley JJ: Vascular access. Tech Vasc Interv Radiol. 6(4):176-81, 2003
                                                                          33. Lewis CA et al: Quality improvement guidelines for central venous access. J Vasc Interv Radiol. 14(9 Pt 2):S231-5, 2003
                                                                          34. III. NKF-K/DOQI clinical practice guidelines for vascular access: update 2000. Am J Kidney Dis. 37(1 Suppl 1):S137-81, 2001
                                                                          35. Cicconi S et al: Non-tunneled central venous catheters in adult stem cell transplantation recipients: an effective option. J Vasc Access. 2(4):168-74, 2001
                                                                          36. Abidi SM et al: Factors influencing function of temporary dialysis catheters. Clin Nephrol. 53(3):199-205, 2000
                                                                          37. Oliver MJ et al: Risk of bacteremia from temporary hemodialysis catheters by site of insertion and duration of use: a prospective study. Kidney Int. 58(6):2543-5, 2000