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Treatment and the treatment process

Catheters, PICC lines and ports

Leukemia treatment lasts for months, and during this time many drips, blood transfusions and blood tests are needed. Putting a needle into the small veins of the arm every time is both painful and harmful to the veins. That is why most people have a central venous access device: a catheter, PICC line or port. This topic explains what they are, how they are put in and how to look after them at home.

Last updated: ~6 min read
A thin glowing translucent line on a dark navy background starts in a small vein and runs to a wide, luminous blood vessel in which red cells flow.
Figure 1.Concept: the tip of a thin catheter reaches a large vein near the heart.

01Short answer

A central venous catheter is a thin, flexible tube whose tip sits in a large vein near the heart. Through it, chemotherapy, blood and platelet transfusions, antibiotics, fluids and nutrition can be given, and blood samples can be taken. The main types are: the PICC line, put in through the arm; the tunnelled catheter, run under the skin of the chest; and the port, which sits completely under the skin. These devices protect the veins and reduce the number of needles, but they carry risks of infection, clots and blockage. That is why hygiene, regular care and knowing the warning signs are so important.

02Simple explanation

The small veins of the arm can be irritated and damaged by strong medicines. A large vein near the heart, by contrast, has a wide, fast blood flow, so the medicine is diluted quickly there.

A PICC line is a long, thin tube put in through a vein in the arm above the elbow. Its tip reaches a large vein near the heart. A short length stays outside on the skin under a clear dressing.

A tunnelled catheter is run under the skin of the chest and into a vein near the collarbone. Part of it also stays outside. The “tunnel” under the skin helps hold it in place and protects against infection.

A port is a small chamber under the skin, usually on the chest. It cannot be seen from outside. When treatment is needed, the nurse puts a special needle through the skin into the port’s chamber.

Which device suits you depends on how long treatment will last, the type of medicines, your veins and your lifestyle. Your team makes the choice together with you.

03Scientific explanation

Choosing a device: according to the 2015 ESMO guidelines, the choice of central venous access device depends on the expected length of treatment, the medicines to be given, and the patient’s characteristics and preferences. According to Cancer Research UK, types of central line include the acute (short-term) central line, the tunnelled central line, the PICC line and the port (a totally implantable venous access device).

Putting it in: according to Cancer Research UK and Macmillan, a PICC line is put in by a doctor or nurse under local anaesthetic, using ultrasound to find the best vein; an X-ray or ECG may then be done to check the tip is in the right place. A PICC line can stay in for several months. A port is usually put in in an operating theatre or radiology unit under local (sometimes general) anaesthetic and stays in for as long as treatment is needed.

Care: according to Cancer Research UK, a PICC line is checked and flushed with saline each time it is used; when treatment is not being given, it needs cleaning and flushing weekly. MedlinePlus describes regular dressing changes with strict cleanliness. A port that is not in use is flushed regularly. Only a special Huber needle is used to access a port.

Preventing infection: the 2011 US guidelines for preventing catheter-related infections stress hand hygiene, cleaning the skin with chlorhexidine, sterile dressings and removing a catheter promptly once it is no longer needed. According to Cancer Research UK, if an infection develops, antibiotics are needed straight away; otherwise the line may have to be removed and a new one put in.

04What happens in the body?

In everyday life

Keeping the catheter dry is important. Protect the dressing with a waterproof cover when showering; swimming and lying in a bath are usually not advised with catheters that have an external part, so check with your team. Do not pull on the external part, keep the clamps closed and keep sharp objects away from it. With a port, once it has healed, you can usually move more freely.

Flushing and dressings

To stop the catheter from blocking, it is flushed regularly with saline, sometimes with heparin. The clear dressing and connector caps are changed at set times. Usually a nurse does this; sometimes you or someone close to you is taught to do it at home. Do not touch the catheter without washing your hands, and do not carry out any procedure you have not been taught.

A small round chamber glowing softly beneath a semi-transparent layer of skin on a dark navy background, with a thin tube leading away from it.
Figure 2.A port is a small chamber that sits under the skin.

Warning signs

Redness, swelling, pain, pus or discharge where the catheter leaves the skin; fever or chills, especially after the line is flushed; swelling and pain in the arm, neck or face; pain during flushing; a cracked or leaking catheter, or one that has slipped outwards; sudden shortness of breath or chest pain. In any of these cases, contact your team or emergency services straight away.

A soft teal protective ring of light around a thin translucent catheter on a dark navy background; tiny particles around it drift away.
Figure 3.Cleanliness and care protect the catheter from infection.

If the catheter is damaged

If the catheter cracks or is cut, clamp or fold it above the damaged part, cover it with a clean dressing and go to hospital straight away. If the catheter comes out completely, press on the exit site with a clean dressing. Always keep your team’s phone number with you, just in case.

Removal

When treatment is over, the catheter is removed. A PICC line is usually removed in a few minutes, painlessly, as an outpatient. Removing a tunnelled catheter takes a little longer and may need a local anaesthetic. A port is removed with a small procedure. Your team decides when the device should come out.

05How does a central venous catheter work?

Four steps from placement to removal.

Placement — Under local anaesthetic with ultrasound guidance.1PlacementUnder local anaesthetic with ultrasound guidance.
Check — The tip position is confirmed by X-ray or ECG.2CheckThe tip position is confirmed by X-ray or ECG.
Use — Medicines, blood, fluids and tests through one access point.3UseMedicines, blood, fluids and tests through one access point.
Protection — Cleanliness, flushing and dressings prevent infection.4ProtectionCleanliness, flushing and dressings prevent infection.
Fewer needlesThe veins are protected.
Infection riskA fever must be reported straight away.
Long-term accessCan be used for months.

06Comparing central venous access devices (simplified)

DeviceWhere it sitsFeatures
PICC lineFrom an arm vein to a large vein near the heartEasy to put in and remove; can stay several months; weekly care
Tunnelled catheterUnder the chest skin into a vein by the collarboneLong-term; may have several channels; an external part remains
PortCompletely under the skin, usually on the chestNot visible; a Huber needle each time; more freedom once healed
Acute central lineA vein in the neck, under the collarbone or in the groinShort-term, usually in hospital
Peripheral cannulaA small vein in the arm or handFor short treatments; not a central vein

* Your team decides which device suits you and how it should be cared for. At home, only do the procedures you have been taught.

07Key terms

Central venous catheter
A thin tube whose tip sits in a large vein near the heart.
PICC line
A peripherally inserted central catheter, put in through the arm.
Tunnelled catheter
A long-term central catheter run under the skin.
Port
A chamber under the skin with a catheter attached.
Huber needle
A special angled needle used to access a port.
Flushing
Pushing fluid into the catheter to stop it blocking.
Clamp
A clip that keeps the catheter closed when not in use.
Exit site
The point where the catheter comes out of the skin.
Thrombosis
A blood clot forming in the vein around the catheter.
Extravasation
Leakage of a medicine outside the vein.

08Key points

  • A central catheter protects the veins and reduces needles.
  • The main types are the PICC line, tunnelled catheter and port.
  • Medicines, blood and tests go through one access point.
  • Keep the catheter clean and dry.
  • Wash your hands before touching it.
  • Fever and chills are urgent signs.
  • A swollen arm or neck can be a sign of a clot.
  • At home, only do the care you have been taught.

09Frequently asked questions

Does it hurt to have a catheter put in?

A local anaesthetic is usually given, so you may feel pressure during the procedure, but there should be no sharp pain. The area may be a little sore for a few days afterwards. Children often have a general anaesthetic or sedation.

Can I shower with a catheter?

Usually yes, but the dressing must be protected with a waterproof cover. Swimming is usually not allowed with catheters that have an external part. Ask your team about the rules for your device.

PICC line or port: which is better?

Each has its advantages. A PICC line is easier to put in and remove, while a port is not visible and limits daily life less. The choice depends on how long treatment will last and other factors.

Can I exercise with a catheter?

Light activity is usually fine. Heavy lifting with the catheter arm, contact sports and swimming usually need to be avoided. Ask your team what you can and cannot do.

Can I go through a metal detector with a port?

Yes, usually without any problem. Some people carry a card saying they have a port. Tell the doctor about your port before medical scans such as MRI.

What should I do if my catheter is blocked?

Do not try to force a flush yourself. Call your team; a nurse will try to clear the blockage with special methods, or the team will decide whether the catheter needs replacing.

10Questions for your doctor

Take these questions to your appointment. The ones you save are collected on the “My questions” page and stay on this device only.

  1. Which line do I need: a peripheral cannula, a PICC or a port?

  2. How should I care for the line at home?

  3. Which signs could mean a line infection or a clot?

  4. When will the line be removed?

My questions

12Sources

  1. Cancer Research UK. Central lines
  2. Cancer Research UK. PICC Lines (Peripherally inserted central catheter)
  3. Cancer Research UK. Portacaths
  4. Macmillan Cancer Support. PICC line for chemo
  5. Macmillan Cancer Support. Implantable ports
  6. Macmillan Cancer Support. Central lines for chemotherapy and other drugs
  7. MedlinePlus (U.S. National Library of Medicine). Central venous catheters — ports
  8. MedlinePlus (U.S. National Library of Medicine). Central venous catheter — flushing
  9. MedlinePlus (U.S. National Library of Medicine). Peripherally inserted central catheter — flushing
  10. MedlinePlus (U.S. National Library of Medicine). Peripherally inserted central catheter — dressing change
  11. American Cancer Society. Chemo Infusions or Injections
  12. National Cancer Institute (NCI). Chemotherapy to Treat Cancer
  13. Annals of Oncology, 2015. Central venous access in oncology: ESMO Clinical Practice Guidelines
  14. Clinical Infectious Diseases, 2011. Summary of recommendations: Guidelines for the Prevention of Intravascular Catheter-related Infections
Medical disclaimerThis information is for educational purposes only and does not replace medical advice.
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