About central venous catheters

One decision you may need to make before beginning chemotherapy is what type of central venous catheter (CVC) you want your oncologist to insert for your treatment. A CVC, sometimes called a central line, is inserted into a large vein in the chest or upper arm.

Catheters are long, hollow plastic tubes that make it easier to put medication, blood products, nutrients, or fluids directly into your bloodstream. A CVC can also make it easier to take blood samples for testing.

Your oncologist may also decide a CVC is necessary if you’ll need to have:

  • continuous infusion chemotherapy
  • treatment that lasts for 24 hours or more
  • treatment while at home

Some chemotherapy drugs are considered harmful if they leak outside your veins. These are called vesicants or irritants. Your oncologist may recommend a CVC to prevent this from occurring.

CVCs are considered more manageable than a regular intravenous (IV) catheter because they can stay in your body longer. Some CVCs can be left in your body for:

  • weeks
  • months
  • years

A regular IV catheter can only stay in for a few days. This means your oncologist or nurse will have to reinsert multiple IVs into your veins over the course of your treatment which can damage small veins over time.

There are different types of CVCs. The most common are peripherally inserted central catheters, or PICC lines, and ports. The type of CVC you’ll need depends on a few of the following factors, including which one your oncologist prefers:

  • How long you’ll need chemotherapy
  • How long it takes to inject your chemotherapy doses
  • How many drugs you’ll receive at once
  • Whether you have any other medical problems like blood clots or swelling

A PICC line is put into a large vein in the arm by your oncologist or a specially trained nurse. The insertion doesn’t require surgery. Once the PICC is in place, the catheter tube will stick out of your skin. These are known as “tails” or lumens, and you may have more than one.

Having catheters, including PICCs, outside of your body carries a risk of infection.

To reduce the risk, you’ll need to take special care of the tube and the skin that surrounds the area where the line is inserted. The tubes also must be flushed every day with sterile solution to prevent blockage.

A port is a small drum made of plastic or metal with a rubber-like seal across the top. A thin tube, the line, goes from the drum into the vein. Ports are inserted under the skin in your chest or upper arm by a surgeon or radiologist.

After the port is put in place, you may only notice a small bump. There won’t be a catheter tail outside of the body. When it’s time for the port to be used, your skin will be numbed with a cream and a special needle will be inserted through the skin into the rubber seal. (This is called accessing the port.)

Although PICC lines and ports have the same purpose, there are a few differences between them:

  • PICC lines can stay in for several weeks or months. Ports can stay in as long as you need treatment, up to several years.
  • PICC lines require daily special cleaning and flushing. There’s less to care for with ports since they’re under the skin. Ports also need to be flushed about once a month to prevent clotting.
  • PICC lines shouldn’t be allowed to get wet. You’ll need to cover it with waterproof material when you bathe, and you won’t be able to go swimming. With a port, you can bathe and swim once the area has completely healed.

To help get a better idea of what having a CVC may mean for you, you may want to ask your oncologist these questions:

  • Why are you recommending I should have a catheter or port?
  • What are the possible problems that can happen with a PICC or port?
  • Is inserting a catheter or port painful?
  • Will my health insurance cover all of the costs due for either device?
  • How long will the catheter or port be left in?
  • How do I take care of the catheter or port?

Work with your oncology treatment team to understand all the benefits and risks of CVC devices.