A Seldinger technique for the insertion of tunneled fixed-hub total parenteral nutrition catheters

Total parenteral nutrition lines are commonly tunneled subcutaneously to decrease rates of sepsis. The history of line tunneling is discussed briefly, noting that to date a surgical approach, a detachable hub catheter or more recently a tunneling rod and 'peel away' introducer have been necessary for this form of central venous access. These systems have problems associated with cost, catheter type and insertion technique. A simple technique for insertion of tunneled total parenteral nutrition catheters is described. The device used consists of a polyurethane catheter with a fixed-hub. The applications of this approach are discussed.