Catheter/Port Placement
Catheters and ports are placed using a combination of x-ray and ultrasound guidance. A small needle is advanced into the target vein. A wire is advanced through the needle through that vein, centrally. The needle is exchanged over the wire for the catheter, and then the wire is removed, leaving the catheter behind.
Ports require an additional, small incision on the chest. The port is placed beneath the skin and connected to the catheter. The incision is then closed with sutures and glue.
These procedures have a low risk of bleeding, infection, and damage to nearby organs. They can be performed on inpatients and outpatients. Inpatients can return to their room almost immediately after the procedure. Outpatients typically return home after the procedure.
Peripherally Inserted Central Catheter Placement (PICC)
One type of catheter is a peripherally inserted central catheter (aka a PICC line). This catheter enters one of the big veins of the arm and courses through those veins all the way to the heart. It is usually placed for short to moderate duration (greater than 2 weeks but less than 6 month) treatments.
Tunneled Central Venous Catheter (TCVC)
Another type of catheter is a tunneled central venous catheter (aka a TCVC). This catheter typically courses under the skin of the chest until it enters the large vein of the neck (the internal jugular vein). It then descends through that vein centrally. It is placed for short to long duration (greater than 2 weeks up to life-long) treatments.
Of note, TCVC’s are functionally similar to a PICC line and can be used when a PICC line is not recommended (such as in a patient with contractures, indwelling pacemaker/defibrillator, or chronic kidney disease)
Port-A-Cath (Port)
Another type of long term catheter is a port-a-cath (aka Port). A small, round partially metal and partially rubber structure is placed under the skin of the upper chest. It is connected to a small catheter which courses under the skin of the chest until it enters the large vein of the neck (the internal jugular vein). It then descends through that vein centrally. In order to access the port, a needle has to be advanced through the skin of the chest into the port. It is usually placed for moderate to long duration (greater than 6 weeks up to life-long) treatments that are given intermittently, such as chemotherapy.
