For tunneling of the catheter, remove the wet gauze and reidentify the isolated IJV segment, then choose a target entry site for catheter introduction subcutaneously at the same depth as the IJV, deeper than the sternocleidomastoid, and between the two coated and braided non-absorbable suture ties. Hold the Hickman catheter introducer in the dominant hand in the dorsal surgical field and suspend the remaining length of the catheter in the air above the sterile field. The non-dominant hand should be in the ventral surgical field.
Insert the introducer into the exit puncture site with the dominant hand, pointing the tip of the device toward the non-dominant hand in the ventral field. Push the tip of the introducer superficially and medially to tunnel the catheter through the adipose tissue, feeling for the emergence of the tip with a non-dominant hand. Once the tip emerges at the target entry site, pull the introducer and catheter through the subcutaneous tunnel until the cuff of the main line is just underneath the surface of the skin of the dorsal field.
