Tunnelled CVCs

CVCs are long-term, large bore, silicone tubes that are commonly inserted into the body via the subclavian, jugular or femoral veins, so that the catheter tip is positioned in the superior vena cava just above the right atrium or the inferior vena cava, hence the term central access.

Two stitches are used to secure the catheter in position until it is removed. Once secured, a small dressing is placed over the site of the insertion.

The flow of blood around the catheter in the superior vena cava is much higher than in a peripheral vein, which enables irritant drugs or fluids to be infused without damaging the vein walls.

Tunnelling the CVC under the skin away from where it enters the body holds the catheter firmly in place and acts as a mechanical barrier to bacteria.

Tunnelled CVCs are fitted with a small cuff which enables the patient’s body tissue under the skin to gradually encircle the cuff and maintain the CVC in position. This process takes about 21 days during which time the line is kept in place by several stitches. Once the CVC is secured, the stiches can be removed.

  • Tunnelled CVCs may have single or multiple lumens, each of which is fitted with a clamp or other type of sealing device.
  • Patients with tunnelled CVCs can return home between treatments. The healthcare team therefore encourage patients to be independent in managing their tunnelled CVC.

Complications and the symptoms they create that patients need to be aware of and report to their healthcare team are:

  • Infections indicated by: Red, warm, swollen areas around the cathete or fever, shortness of breath or dizziness
  • Thrombosis: Ultrasound is recommended and anticoagulants if appropriate
  • Bleeding
  • Blockages which can cause painful or bruised areas around the catheter
  • Leakage of fluid (infiltration or extravasation)
  • Damages to the catheter tube which can be repaired depending on the extent of the damage

Intravenous infiltration

Intravenous infiltration occurs when IV administered fluids leak into the surrounding tissue. Extravasation is the leak of vesicant agents that can cause tissue necrosis or blister formation, into tissues around the IV site of its administration. 

Administration of chemotherapy vesicants such as daunorubicin, doxorubicin and vincristine, can result in accidental extravasation leading to serious complications.

Both IV infiltration and extravasation can cause potentially serious complications and result in tissue damage or necrosis that may need urgent treatment