Clinical Procedure
 
Aliases:
Tunnelled cvc
Tunnelled line
Tunneled lines
Tunneled line
Tunneled CVC

Topic aliases are alternate phrasings for a particular topic.


In children the tunnelled CVC does not require a repeat anaesthetic to remove as is required for a broviac central-line.

It can simply be pulled out with some pressure applied to the entry point at the internal jugular vein unlike the broviac line which requires dissection around the subcutaneous cuff to release the catheter.

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Suitable for patients requiring medium term (2-6 weeks) intravenous therapy.

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Given that you are introducing a large diameter sheath (eg 5fr) you want to be sure you are not in the carotid.

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If the line tip ends up a little short of the intended position consider that the subcutaneous path of the line may not be a direct as it could be.

Reintroducing the wire (to stiffen the line) and massaging the the line through the skin up towards the internal jugular entrance point may help loosen up the connective tissue and straighten the path.

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The lower approach to the internal jugular vein is usually better to minimise the degree of direction change of the catheter.

If the patient is coagulopathic a higher approach that is more amenable to compression may be more appropriate.

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Example tray setup

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If using a double lumen CVC the needle and wire are usually smaller than a single lumen.

For this reason you need to use a dilator to make a subcutaneous path from the exit point to the insertion point.

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