Comprehensive Nursing Pharmacology Q 9
What is the purpose of “Tunneling” (inserting the catheter 2-4 inches under the skin) when the surgeon inserts a Hickman central catheter device?
A. Increases the patient’s comfort level.
B. Decreases the risk of infection.
C. Prevents the patient’s clothes from having contact with the catheter.
D. Makes the catheter less visible to other people.
Correct Answer: B. Decreases the risk of infection.
The actual access to the subclavian vein is still just under the clavicle, but by tunneling the distal portion of the catheter several inches under the skin the risk of migratory infection is reduced compared to a catheter that enters the subclavian vein directly and is not tunneled. The catheter is tunneled to prevent infection.
Option A: There are two types of central venous catheters: tunneled and non-tunneled. Tunneled CVC’s are placed under the skin and meant to be used for a longer duration of time. Non-tunneled catheters are designed to be temporary and may be put into a large vein near the neck, chest, or groin.
Option C: Tunneled CVC have requirements that are unparalleled by other access devices: high blood flow rates at moderate pressure drops without obstruction, minimal trauma to the vein, resistance to occlusion by fibrous sheathing, prevention of infection, avoidance of clotting, biocompatibility, avoidance of lumen collapse and kinking and breaks, resistance to antiseptic agents, placement with minimal trauma, and radiopaque appearance on X?ray.
Option D: Over 70% of patients initiating chronic hemodialysis in the United States have a tunneled central venous catheter (CVC) for dialysis as their first blood access device. The use of dual lumen CVC for removing and returning blood during dialysis is commonplace now but in the late 1970s, this concept revolutionized dialysis. Before the development of CVC for dialysis, dialysis was possible only with arterial access, through an internal/external AV silicone shunt or through separate catheters placed into an artery and a vein and removed after each treatment.