Some patients may require long-term, intermittent treatment with intravenous medications. Interventional Radiologists at HRA can place catheters into the veins of these patients, so that they can receive their medications comfortably and reliably.
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)
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.
If a catheter is not working well, it may require revision. Depending on the catheter/port type, this may require placement of a new catheter with removal of the old catheter or exchange of the indwelling catheter over a wire for a new on.
When a catheter or port is no longer needed, it should be removed. All removals have a low risk of bleeding, infection, and damage to adjacent structures, and they can be performed on inpatients and outpatients.
PICCs can be removed by the ordering physician in the office without special equipment/training.
TCVCs are usually removed by Interventional Radiology. The holding suture is cut. The catheter is removed with manual traction. The whole process usually takes about 15 minutes and is performed at bedside. The patient is then may return to their room or home.
Since ports are completely underneath the skin, patients with a port need to return to Interventional Radiology for removal. The patient is given medication to help him/her relax. The area over the port is numbed with local anesthetic. An incision is made near the port. Then, the port and catheter are removed. Finally, the incision is closed again with sutures underneath the skin. The whole process usually takes approximately 15 minutes. After the procedure, inpatients may return to their room and outpatients may return home.