Patient guide
PICC line, tunnelled catheter and chemo port: image-guided placement explained
What a PICC line, tunnelled central catheter and implanted chemo port are, how they differ, how they are placed under ultrasound and X-ray, how to care for them, and the risks of clots and infection.
Central venous access at a glance
- A small punctureNo major surgery
- Local anaestheticYou stay awake
- Ultrasound and X-rayTip position is confirmed
- Day-careHome the same day
- About 20-45 minutesFor most placements
- Fewer needle sticksTreatment goes through one access
Why a central line is needed
Some treatments are too harsh for small arm veins, or are needed for weeks or months. Chemotherapy can damage the vein wall, and repeated cannulation becomes painful and difficult. A central venous catheter delivers medicines into a large vein near the heart, where they are diluted quickly, and can also be used to draw blood tests.
PICC, tunnelled catheter and port compared
All three end in the same large central vein. They differ in where they enter and how they are worn.
| PICC line | Tunnelled catheter | Implanted port | |
|---|---|---|---|
| Where it enters | A vein in the upper arm | A vein in the neck, then tunnelled under the chest skin | A neck or arm vein, with a chamber under the chest skin |
| What is visible | A tube and cap outside the arm | A tube and cap outside the chest | A small bump under the skin, nothing outside |
| Usual duration | Weeks to a few months | Weeks to months | Months to years |
| Day-to-day care | Regular flushing and weekly dressing | Regular flushing and dressing | Flush after use and regularly when idle |
| Swimming and showers | Covered, with limits | Covered, with limits | Free when not accessed |
How it is placed
Placement takes about 20 to 45 minutes.
- Blood tests are checked, and you are asked about blood thinners.
- Ultrasound finds a suitable vein, and the skin is numbed with local anaesthetic.
- A needle enters the vein, and a guidewire is passed. X-ray (fluoroscopy) follows the wire to the right position.
- The catheter is placed, with its tip in the lower part of the large vein above the heart. For a port, a small pocket is made under the skin of the chest and the chamber is connected and stitched in place.
- X-ray confirms the tip position, and the line is flushed and ready to use.
Risks: clots and infection
The main concerns are clots in the vein (thrombosis), infection and blockage. In a pooled analysis of 64 studies and 29,503 patients, PICCs were associated with a higher risk of arm vein thrombosis than other central lines (odds ratio 2.55), and PICC-related clots occurred in 6.7% of people with cancer and 13.9% of critically ill patients [2]. The authors concluded that the decision to use a PICC should weigh clot risk against benefit.
Other possible problems are bleeding or bruising at the site, a catheter that moves, and rarely a collapsed lung or an abnormal heart rhythm during placement.
Chopra et al., Lancet 2013, 64 studies, 29,503 patients [2].
Living with a central line
You will be taught the details for your own device, and the main points are these.
- Keep the dressing clean, dry and intact, and have it changed as scheduled.
- Never let anyone take a blood pressure or draw blood from the arm of a PICC unless advised.
- Flush as taught, to keep it open.
- Call for fever or chills, redness, swelling or pus at the site, a swollen arm, neck or face, pain, a catheter that moves or leaks, or new breathlessness or chest pain.
Kidney disease and dialysis
If you have advanced kidney disease, or may need dialysis in future, tell the team before any line is placed. Vein-sparing advice in dialysis guidelines favours avoiding PICCs, because they can damage the arm veins that a dialysis fistula needs [3]. A tunnelled neck line is usually a better choice in this situation.
Cost and insurance
Health insurance can cover these procedures, subject to your policy terms. The exact cost is calculated after consultation, a complete evaluation of the problem, and a decision on the procedure that suits you. Cashless treatment can be arranged with major Indian health insurers and TPAs, and credit treatment is available for CGHS and Singareni beneficiaries. Eligibility is confirmed after a policy check.
Frequently asked questions
- Is PICC line insertion painful?
- The skin is numbed, so you feel a pinch and pressure. A sore arm for a day or two is usual.
- PICC or chemo port, which is better?
- A port suits long courses of chemotherapy over months to years. A PICC suits shorter courses. The choice depends on your treatment plan, your veins and how you want to live with it [1].
- How long can a PICC line stay in?
- Usually weeks to a few months, as long as it works and there are no problems. A port can stay for years.
- Can I shower with a PICC line or port?
- With a PICC you cover the dressing with a waterproof cover. A port that is not in use has nothing outside the skin, so showering is normal.
- What if my arm swells after a PICC?
- Call the clinic the same day, because swelling can mean a clot in the vein, which needs assessment and often treatment [2].
References
- Sousa B, Furlanetto J, Hutka M, et al. Central venous access in oncology: ESMO Clinical Practice Guidelines. Ann Oncol. 2015;26(Suppl 5):v152-v168. Read the source
- Chopra V, Anand S, Hickner A, et al. Risk of venous thromboembolism associated with peripherally inserted central catheters: a systematic review and meta-analysis. Lancet. 2013;382(9889):311-325. Read the source
- Lok CE, Huber TS, Lee T, et al. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis. 2020;75(4 Suppl 2):S1-S164. Read the source
Want to discuss your options?
Speak with the Clinic Seven team.