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Treatment and the treatment process

Which access for which situation

Venous access comes in several forms: an ordinary cannula in the arm, a PICC line, a neck catheter, a tunnelled chest line and a port. This topic compares, in simple terms, which one is chosen in which situation.

Last updated: ~3 min read
A cannula, a PICC line, a two-ended tunnelled catheter and a small round port on dark navy cloth.
Figure 1.Four main types of venous access.

01Short answer

Choosing venous access rests on several questions: how long treatment will last, which drugs will be given (those that irritate veins need central access), how often blood will be taken and transfusions given, whether a transplant is planned, the platelet count and clotting, the state of the veins and your lifestyle. As a general rule: a peripheral cannula for short periods and mild drugs; a PICC for weeks to months; a non-tunnelled central (neck) line for fast, multi-channel access in an acute situation; a tunnelled line for intensive long-term treatment and transplant; and a port for infrequent long-term treatment. In acute leukemia, the choice often changes from phase to phase.

02Simple explanation

A peripheral cannula is a small plastic tube in the arm. It suits a few days of mild drugs and fluids.

A PICC is a long thin catheter put in through the arm, with its tip near the heart. It can stay for weeks or months.

A neck catheter is quick to place and has several channels. It is used at the start of treatment and in urgent situations.

A tunnelled line and a port stay for months. The first suits intensive treatment, the second less frequent treatment.

03Scientific explanation

The drug matters: according to CRUK and the ACS, drugs that strongly irritate veins or damage tissue if they leak (vesicants), such as anthracyclines, are usually given through central access.

Number of lumens: during induction for acute leukemia and transplant, chemotherapy, blood, antibiotics and fluids may run at the same time. A multi-lumen (2–3 channel) line makes this easier.

Lowering risk: per CDC guidance, using no more lumens than needed and removing an unneeded line promptly reduce infection risk. If platelets are very low, a platelet transfusion may be given before placement.

04What happens in the body?

What shapes the decision?

Length and intensity of treatment; type of drugs; platelet count and clotting; infection risk; the state of your veins; past line problems; your lifestyle and preferences.

A crossroads of four glowing paths of different tints under a starry dark navy sky.
Figure 2.The right path is chosen for each situation.

A typical sequence in acute leukemia

At diagnosis, a neck line or PICC is often placed because fast multi-channel access is needed. If treatment goes on or a transplant is planned, a tunnelled line may follow. In chronic leukemias treated with tablets, no permanent access is often needed at all.

A translucent body silhouette on dark navy with glowing points at the back of the hand, upper arm, neck and chest.
Figure 3.Typical access sites.

Questions worth asking

Which access is planned for me, and why? How long will it stay? How is it cared for? What about showering, work and sport? When should I call?

05Four questions behind the choice

Your team answers these to decide.

Duration — Days, weeks, months?1DurationDays, weeks, months?
Drugs — Do they irritate veins?2DrugsDo they irritate veins?
Veins — What state are they in?3VeinsWhat state are they in?
Plan — The right access is chosen.4PlanThe right access is chosen.
ShortCannula, neck line.
MediumPICC.
LongTunnelled line, port.

06Comparing venous access

AccessDurationWhen is it chosen?
Peripheral cannulaDaysShort, mild treatment, fluids
PICCWeeks–monthsMedium-length chemotherapy, antibiotics
Neck (non-tunnelled) lineDays–weeksUrgent, at the start, multi-channel access
Tunnelled lineMonthsIntensive treatment, transplant
PortMonths–yearsInfrequent long-term treatment

* Durations are approximate; your team may decide differently.

07Key terms

Peripheral cannula
A short plastic tube in an arm vein.
PICC
A peripherally inserted central catheter, placed through an arm vein.
Lumen
A separate channel in a catheter.
Vesicant
A drug that damages tissue if it leaks out of the vein.
Tunnelled line
A long-term catheter that runs under the skin.

08Key points

  • The choice depends on duration, drugs and your situation.
  • Irritant drugs need central access.
  • Acute leukemia often needs multi-channel access.
  • The plan can change during treatment.
  • An unneeded line is removed promptly.
  • Tell your team about your lifestyle.

09Frequently asked questions

How does a PICC differ from a port?

A PICC comes out of the arm and needs frequent care; a port is fully under the skin and needs little care when not in use.

Can treatment be given without a line?

For some treatments yes, such as tablets. Intensive chemotherapy usually needs central access.

Can I choose the access myself?

You can share your preferences; the final decision is made with your team for safety reasons.

Does one line last the whole treatment?

Sometimes, but it is often changed according to the phase of treatment.

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. How does a PICC differ from a port?

  2. Can treatment be given without a line?

  3. Can I choose the access myself?

  4. Does one line last the whole treatment?

My questions

12Sources

  1. Cancer Research UK. Central lines
  2. Cancer Research UK. PICC lines
  3. Macmillan Cancer Support. Central lines for chemotherapy and other drugs
  4. MedlinePlus. Peripherally inserted central catheter - flushing
  5. Macmillan Cancer Support. Implantable ports
  6. CDC. Guidelines for the Prevention of Intravascular Catheter-Related Infections
  7. MedlinePlus (U.S. National Library of Medicine). Central venous catheters - ports
  8. American Cancer Society. Making Treatment Decisions
  9. National Cancer Institute (NCI). NCI Dictionary of Cancer Terms: port
  10. NHS. Stem cell and bone marrow transplants
Medical disclaimerThis information is for educational purposes only and does not replace medical advice.
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