People with certain diseases or medical conditions sometimes require that ports be placed into the body so that they can receive medications or nutrients directly into the blood stream or gastrointestinal system, or so blood can be drawn. Central venous catheters (CVC) which is a tube that is inserted directly into the vascular system and is connected to a port. PICC (peripherally inserted central catheter) lines are CVCs that are commonly used for patients who will need treatment for more than a couple of weeks and are placed in the arm. Interventional Radiologists specialize in vascular procedures and have perfected minimally invasive ways to insert ports and CVCs without surgery and accompanying stress and pain for the patient.
Ports are recommended for patients who regularly have:
- Chemotherapy treatments
- Infusions of antibiotics or other medications
- Nutritional supplements
What to Expect
For the first week, it is especially important to keep the catheter site clean and dry. Some doctors will recommend sponge bathing around the catheter site, then cleaning the area with peroxide, applying an anesthetic ointment that contains an antibiotic, and bandaging the area. It is important to closely follow the instructions given to you about how to care for the incision and the device. You may be told that it is all right to shower after a week, using a piece of plastic wrap over the catheter insertion site, but not to swim.
Call your doctor, nurse, or interventional radiologist if you have any questions about your vascular access device. You must notify them if problems develop with your catheter. Problems needing medical attention include:
- Malfunction of the device.
- Bleeding at the insertion site.
- Signs of infection such as:
- Increased swelling or tenderness at the catheter insertion site
- Fluid drainage from the site
Why refer to an Interventional Radiologists?
All long-term ports placed should have a groshong tip, therefore, eliminating the need for heparin flushes. Interventional radiologists can also place PICC’s/Ports that are power injectable, so if a patient would need a CT Scan with intravenous contrast, the central access device can be used to deliver the intravenous contrast.
What types of ports and CVCs are available?
Peripherally Inserted Central Catheter (PICC)
The peripherally inserted central catheter (PICC) is also introduced through an arm vein but its tip lies in a large central vein. It typically provides central IV access for up to 4 to 8 weeks. A PICC may remain in place for 3 to 5 months in special cases, as long as it continues to work well and is not infected, but it still is considered to be a temporary catheter. A trained nurse or physician’s assistant can place a PICC at the bedside as long as the veins are close to the surface of the skin and in good shape. Imaging guidance by fluoroscopy or ultrasound (two forms of X-rays) is sometimes necessary, in which case the PICC will be placed by an interventional radiologist. Because a PICC can be cared for at home, patients can often go home from the hospital earlier than with other catheter placements. Any trained health care worker can easily pull the PICC line out when it is no longer needed.
The tunneled catheter, also known as a Hickman, Broviac or Groshong catheter, is a vac3permanent catheter that is fixed in place when scar tissue forms. It is typically inserted into the internal jugular vein (a large vein in the neck). It is then tunneled from the puncture site down onto the chest wall, emerging from the skin about 6 inches from where it entered the vein. The tip of the catheter lies in the large vein that returns blood to the heart. This type of catheteris the best choice when a patient is likely to need access for longer than 3 months and when the line will be used many times each day. It is secure and easy to use. A drawback of these catheters is that a small percentage of tunneled catheters must be removed prematurely due to infection.
The hemodialysis catheter, also known as a Permcath, Quinton or Palindrome catheter, is a permanent catheter that is fixed in place when scar tissue forms. It is typically inserted into the internal jugular vein (a large vein in the neck). It is then tunneled from the puncture site down onto the chest wall, emerging from the skin about 6 inches from where it entered the vein. The tip of the catheter lies in the large vein that returns blood to the heart. This type of catheter is the best choice when a patient is likely to need dialysis for longer than 2 weeks or needs dialysis during fistula maturation. It is secure and easy to use. A drawback of these catheters is that a small percentage of tunneled catheters must be removed prematurely due to infection.
The subcutaneous port is a permanent device made up of a catheter attached to a small basin implanted beneath the skin. The entire device is inside – nothing can be seen on the outside of the skin except for a small bulge. The catheter, which passes from an access site in the neck, ends in a large central vein in the chest. The basin has a silicone covering that can be punctured with a special needle. The port is used mainly when IV access is needed every so often over a long period, as in chemotherapy. Its only drawback is the need for a needle stick whenever treatment is given, but discomfort usually is not marked and tends to decrease over time. Superficial numbing using Hurricane spray can be used for skin anesthesia.