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Treatment and the treatment process

Catheter through the chest

When treatment lasts for months, longer-lasting venous access is needed. This topic covers the two main types placed through the chest, a tunnelled catheter (such as a Hickman line) and an implanted port, and what it is like to live with them.

Last updated: ~3 min read
A translucent view of the chest on a dark navy background: a thin catheter running through a short tunnel under the skin into a vein near the collarbone, with a gold cuff in the tunnel.
Figure 1.A tunnelled line runs under the skin and enters a large vein.

01Short answer

Central lines placed through the chest are for long-term treatment. A tunnelled catheter runs in a short “tunnel” under the skin of the chest wall and enters a large vein near the collarbone; its tip lies near the heart, and its outer ends come out of the chest. A special cuff in the tunnel anchors the line and makes it harder for infection to get in. A port is a small round reservoir placed under the skin; it is accessed with a special needle, and nothing shows on the outside when it is not in use. Both are used for chemotherapy, transfusions, blood tests and transplant, and can stay in for months. The main risks are infection, clots and damage to the line.

02Simple explanation

A tunnelled catheter is a thin tube running under the skin, with one to three ends coming out of the chest. It is convenient when many drugs are needed often, for example during a transplant.

A port is a small “box” under the skin. Showering and swimming are easier, but a special needle goes through the skin each time it is used (numbing cream can be applied first).

Why a tunnel? The point where the line leaves the skin is far from where it enters the vein, making it harder for germs to reach the vein.

How long does it stay? For months, sometimes more than a year, until treatment ends.

03Scientific explanation

Placement: according to CRUK and Macmillan, tunnelled lines and ports are usually placed under local anaesthetic with sedation, sometimes under general anaesthetic, in a sterile room, with ultrasound and X-ray guidance. It takes 30–60 minutes.

The cuff: the Dacron cuff on a tunnelled line grows into the tissue over 2–3 weeks and holds the line in place; after that, the stitches can be removed.

Care: according to MedlinePlus, a tunnelled line is usually flushed weekly and after each use, and the dressing is changed regularly. An unused port is usually flushed every 4–12 weeks; your team sets the exact schedule.

04What happens in the body?

Which one to choose?

The choice depends on the type and length of treatment, how often access is needed and your lifestyle. For intensive acute leukemia treatment and transplant, a multi-lumen tunnelled line is often chosen; for less frequent treatment, a port.

A two-ended tunnelled catheter and a small round port lying side by side on a dark cloth.
Figure 3.Two main types: tunnelled line and port.

Daily life

The ends of a tunnelled line are secured with a dressing or small pouch so they do not pull. Protect the dressing in the shower; no swimming or baths. Once healed, a port hardly affects everyday life.

A small round reservoir with a silicone dome under translucent layers of skin, with a thin tube leading to a vein.
Figure 2.A port is a small reservoir under the skin.

Removal

After treatment, a tunnelled line is removed under local anaesthetic by freeing the cuff. A port is removed with a minor surgical procedure. Both are usually quick.

05The chest line journey

From planning to daily care.

Plan — The type is chosen.1PlanThe type is chosen.
Placement — In a sterile room, with imaging.2PlacementIn a sterile room, with imaging.
Daily life — Secured and protected.3Daily lifeSecured and protected.
Flushing — Regularly, by a healthcare worker.4FlushingRegularly, by a healthcare worker.
Long-termStays for months.
One access pointDrugs, blood, tests.
Watch outCall straight away with fever.

06Tunnelled line and port

FeatureTunnelled linePort
Visible outside?Yes, ends come out of the chestNo, only a small bump
AccessNeedle-free, straight from the endA special needle each time
Number of lumens1–3Usually 1
Showering, swimmingShower with protection; no swimmingAllowed once healed
FlushingOften, usually weeklyLess often when not in use
Better suited toIntensive treatment, transplantLess frequent long-term treatment

* The choice is made together with your team.

07Key terms

Tunnelled catheter
A long-term central line that runs under the skin.
Hickman line
A widely used type of tunnelled catheter.
Port
An implanted access device with a small reservoir under the skin.
Cuff
A small ring that anchors the line in the tissue.
Huber needle
A special needle used to access a port.

08Key points

  • Chest lines provide long-term access.
  • The tunnel lowers infection risk.
  • A port sits fully under the skin.
  • Both are flushed regularly.
  • Protect them from sharp objects and tugging.
  • Call straight away with fever or swelling.

09Frequently asked questions

Will port needles hurt?

Each access is a brief prick; numbing cream helps.

Can I work with a tunnelled line?

Often yes, apart from heavy physical work and movements that pull on the line. Talk to your team.

What if a cap comes off?

Close the clamp if there is one, cover the end with a clean cloth and call your team straight away.

When is the line removed?

When treatment is over and it is no longer needed; sometimes earlier because of infection or a clot.

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. Will port needles hurt?

  2. Can I work with a tunnelled line?

  3. What if a cap comes off?

  4. When is the line removed?

My questions

12Sources

  1. Cancer Research UK. Central lines
  2. Cancer Research UK. Portacaths
  3. MedlinePlus. Tunneled central venous catheter - flushing
  4. MedlinePlus. Central venous catheters - ports
  5. Macmillan Cancer Support. Central lines for chemotherapy and other drugs
  6. Macmillan Cancer Support. Implantable ports
  7. NHS. Blood transfusion
  8. National Cancer Institute (NCI). Adjustment to Cancer: Anxiety and Distress (PDQ®)
  9. MedlinePlus (U.S. National Library of Medicine). Blood Transfusion and Donation
  10. National Cancer Institute (NCI). Fatigue and Cancer Treatment
Medical disclaimerThis information is for educational purposes only and does not replace medical advice.
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