Avoid vein damage with ports and PICCs

When you have chemotherapy treatment, you often have an IV or ‘intravenous infusion’.

A nurse inserts a thin plastic tube (cannula) into your arm or hand so they can give you the drugs.

You may not want to have this done each time. Your veins might be hard to find, or the medications can make your veins sore.

If you have chemotherapy regularly, talk to your doctor or oncology nurse about using a PICC line or port catheter.
Ports and PICCS are ‘central venous access’ devices that give better access to your veins. You don’t have to find a suitable vein each time. They can be used for:

• chemotherapy drugs
• blood transfusions
• antibiotics
• injecting ‘contrast’ for scans (in some health centres)
• taking blood for tests.

How to make veins easier to access

If you have IV chemotherapy, you can do a few things to make your veins easier to find:

• Drink plenty of fluids before your treatment.
• Don't wear sleeves that are too restrictive or tight.
• Try to relax
• Keep your hands, arms and body warm. A hot-water bottle, wheat pack, or running your arm and hands under warm water just before chemotherapy can all help.

If you really hate needles, your doctor or oncology nurse might also suggest:

• numbing the skin over the vein an hour before treatment using an anaesthetic cream.
• relaxation techniques to reduce your anxiety
• anxiety-reducing medications.

About ports (port-a-caths)

‘Port’ is the simple name for a ‘port-a-cath’ or ‘infusaport’. This device gives easy access to your veins and is known as a ‘central venous access device’.

It provides access via a very thin, flexible tube that feeds directly into one of the major veins near the heart.

A port is inserted or implanted under the skin. Usually this is in your chest wall or, less commonly, the arm.

The procedure to insert the port is small. It can be done:

• under local anaesthetic in the radiology department
• in day surgery under light anaesthetic.

Each time you have treatment, the chemotherapy nurses insert a needle through your skin into the port. They can put a numbing patch on your skin if the needle is too painful. Accessing the port is generally much easier than finding a vein.

You need to be extra careful about avoiding an infection in your port because it feeds directly into your heart. The nurses will access your port under sterile conditions, to lower the risk of an infection.

You can go swimming if you have a port and do your usual activities.

You keep your port in place for as long as you need it, and it can be removed when you have finished treatment.

If you don’t have a port when you start your chemotherapy treatment, you can ask whether it’s possible at any time. Chemotherapy nurses may suggest you have a port inserted if they have difficulty finding your veins.

About PICC lines

An alternative to a port is PICC line – a ‘peripherally inserted central catheter line’.

A PICC is usually inserted into a vein in the arm near the elbow. It travels into a larger vein near the heart.

The procedure to insert the PICC is usually done under local anaesthetic in the radiology or outpatient department.

This takes about 30 minutes. Afterwards you need a chest X-ray to check that the PICC is in the right position.

A PICC can be used in hospital or at home. It can stay in place for weeks or months if needed. 

Advantages of ports and PICCs

There are multiple reasons you may want a port or PICC instead of a cannula.

Ports and PICCs can both:

• relieve your veins from the frequent ‘needle sticks’ for chemotherapy and blood tests
• spare your veins and blood vessels from the effects of intravenous medications. Over time, IV medications can make your veins sore or scarred. You may not be able to use the same veins for treatment or taking blood.

Other advantages of ports

• A port is under the skin and does not need a dressing. This means you are less likely to develop an infection.
• A port is less visible and intrusive than a PICC line. When you have a port, you only see a small swelling under the skin.

Other advantages of PICCs

• PICCs are easy to remove.

Disadvantages of ports and PICCs

Disadvantages of ports

• A port may mean another hospital procedure and another scar.
• Ports need to be flushed at least every 6 to 8 weeks to work properly, even if you are not having treatment.
• Having a port increases your risk of getting an infection. Sometimes ports need to be removed or replaced because of an infection or a blockage.

Disadvantages of PICCs

• A PICC is held in place by a dressing that needs to be changed at least once each week.
• There is a risk of infection with the part of the catheter that sits outside on the skin.
• The PICC line needs to be flushed at least once each week to prevent a blockage – the oncology nurse will do this for you. They may be able to visit you at home to do this, if your treating centre offers this service. In rural or regional Australia, your treating centre can refer you to your local district nursing service for PICC care.
• A PICC is not the best option if you like to swim because there is a higher risk of infection.