Various catheter-securing techniques have been described to prevent
dislodgment of the catheters. The catheter can be tunneled subcutaneously
to significantly decrease the chance of dislodgment. There are
basically two approaches to tunneling the catheter: (1) tunneling without
and (2) tunneling with a “skin bridge.” Leaving a skin bridge makes catheter
removal easier and is normally used for a short-term (1 to 7 days)
catheterization, whereas tunneling without a skin bridge is typically used
for long-term infusion (>7 days) catheterization and has the
potential advantage of preventing infection. The first method may be
associated with more leakage at the skin–bridge area, whereas the latter
method may make catheter removal more difficult.
With a commonly used technique, the inner steel stylet of the Tuohy
needle is used as a guide. If a skin bridge is planned, the needle enters
the skin 2 to 3 cm from the catheter exit site, but through the catheter exit
site (taking special care not to damage the catheter) if a skin bridge is
not wanted. The stylet is then advanced subcutaneously for approximately
8 to 10 cm. The Tuohy needle is then “railroaded” back over the stylet, the
stylet is removed, and the distal end of the catheter advanced retrogradely
through the needle. The needle is then removed, and the catheter is
tunneled. If a skin bridge is left, a small piece of plastic or silicone
tubing can be inserted to protect the skin under the skin bridge. Various adhesive materials and methods have been used with success
(eg, medical adhesive spray, Steri-Strips, and transparent occlusive
dressings).25