Long-term IV Access & Types of Ports
Taking the sting out of frequent treatments and procedures.
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From needle sticks and blood draws, from injections to IVs, everybody has had their shots. Usually, a pinch is all there is to it. But many conditions, such as cancer treatment, long-term IV medication or kidney dialysis, require frequent or constant access to your veins. Repeated needle sticks in the same area can be hard on you and hard on your veins. That’s why we specialize in placing vein access ports, so that doctors don’t have to stick you with a needle or restart an IV line every time you need treatment. That makes care easier — and your life easier.
With our combination of vascular expertise and precise imaging, we specialize in placing a wide variety of vein access devices, including:
Long-term IV Access
Placing a semi-permanent catheter such as a “port-a-cath,” chemotherapy port or IV access port into a large vein in the upper arm or neck can make treatment easier for patients undergoing treatments that require frequent or constant vein access.
- Chemotherapy or anti-cancer drug infusions
- Hemodialysis
- Long-term intravenous antibiotic treatment
- Long-term intravenous feeding
- Repeated drawing of blood samples
These ports can remain in place for several weeks or months and can help patients in many ways:
- Fewer needle sticks to draw blood
- Multiple IV lines accessible at one site
- Lowered risk by reduced leakage, which is particularly important with chemotherapy agents that can cause tissue or muscle damage if they leak
Types of Long-term IV Ports
Port-a-cath:
Unlike most other types of catheters, a port-a-cath is implanted completely underneath the skin. This type of port allows you to bathe and swim without the risk of infection. Port-a-caths can remain in place for months or even years.
Peripherally inserted central catheters (PICC):
A PICC line is inserted into one of the large veins in the arm near the elbow. PICC lines are generally used for shorter periods (one to six weeks) and are easier to remove.
Central line, tunneled venous catheters or Hickman catheters:
These types of catheters are inserted into a large vein under the collarbone or in the neck and leave the body through a separate exit point, usually the upper chest. A “cuff” secures the line, providing protection from infection and holding the catheter in place as your body heals around it.
We work with you and your health care team to choose the best long-term IV access option for your situation.
Dialysis Access
A crucial step before starting hemodialysis treatment is preparing vein access, usually in your arm or leg. A high volume of blood is continuously removed and returned during dialysis, so we want to maximize the amount of blood cleansed in each treatment.
There are three access options for the dialysis patient:
AV Fistula
An AV (arteriovenous) fistula is a surgical connection of one of your own arteries to a vein under the skin of your arm. It’s the most natural dialysis access because it’s made with your own blood vessels. An AV fistula requires planning ahead, because the fistula takes awhile to develop after minor surgery. AV fistulas are less likely than other techniques to form clots or become infected, tend to last many years and can be tolerated by most people. However, if your veins are too small or too weak for a fistula, there are other options.
AV Graft
An AV graft is a surgically inserted tube that connects to a vein and an artery as an artificial vein and fistula. If you have small blood vessels that won’t develop into a fistula, an AV graft may be a good option. It can be used sooner after placement, often within two or three weeks. AV grafts may have more problems with clotting and infection, and need replacement sooner. However, a well-cared-for AV graft can last several years.
Central Venous Catheter
If your kidney disease has progressed quickly, or an AV fistula or graft is unsuccessful, you may not have time to get a permanent dialysis access before you start hemodialysis treatments. A central venous catheter in your neck, chest or near the groin is a good and usually temporary solution. Central venous catheters are not ideal for permanent vein access, because they sometimes clog, become infected or cause narrowing of the veins in which they are placed. But if you need to start hemodialysis immediately, they will work for several weeks or months while your permanent access point develops. If they are needed for more than a few weeks, they will often be placed under the skin for more comfort and a lower risk of complications.
IV Filter Placement
In addition to placing vein access, our expertise in guided imaging allows us to precisely place IVC filters directly inside veins. Inferior vena cava (IVC) filters are small metal devices placed in patients at risk of developing blood clots or deep vein thrombosis in the legs or pelvis; the clots can break off and cause pulmonary embolism, the lodging of an embolus, such as a blood clot, in the lungs. Your doctor may recommend an IVC filter for conditions such as:
- Deep vein thrombosis (DVT)
- Pulmonary embolism
- Trauma
- Immobility
- Recent surgery or childbirth
Using guided imaging, we insert a catheter into a larger vein in the neck or groin and guide the filter in the inferior vena cava (the large vein that takes blood back to the heart), typically just below the kidneys. Once released, the filter expands and attaches itself to the walls of the blood vessel to trap clots that may be working their way up into the lungs. This minimally invasive protective procedure is quick and virtually pain-free.
Other Resources
About Cancer — VCU Massey Comprehensive Cancer Center
Catheters and Ports in Cancer Treatment — Cancer.net
Chemotherapy, What to Expect — Cancer.net
Chemotherapy Principles and Options — American Cancer Society
Questions and Answers about Chemotherapy — National Cancer Institute
Infusion FAQ’s — National Home Infusion Association