Catheters and ports

Patients whose treatment requires intravenous (IV) access for more than seven to 10 days may benefit from vascular access placement. Other patients have veins that make it difficult to place an IV, making the only option.

A central catheter is a long, thin, flexible tube inserted into a vein in the arm, neck or chest just beneath the collarbone. Once inside the body, the tube is threaded into the major vein in the center of the chest. Central catheters allow the delivery of liquid medication and nutrients. Pressure can also be monitored in the large vein, which helps assess heart function.

A shorter, thin, flexible tube is inserted into a vein near the elbow and threaded through the large vein in the upper arm. It cannot be used with some of the more irritating medications, but can be inserted by a nurse at the bedside without the need for guided imaging.

This type of catheter is also inserted into an arm vein, but its tip lies in a central chest vein. It can remain in place for three to six months, but is still considered temporary. If the superficial veins are good, a nurse can put this kind of catheter in place at the bedside. However, imaging guidance and the expertise of a radiologist is necessary in approximately half of all cases.

A tunneled catheter is a permanent catheter that is fixed in place when tissue forms around a cuff beneath the skin. It is inserted through either the internal jugular vein in the neck or the subclavian vein just below the collarbone. It is threaded into the chest wall and emerges from the skin about six inches from where it was inserted. This type of catheter is useful in patients requiring multiple line uses a day for more than three months. However, 10 to 15 percent of these catheters must be removed due to infection, so they must be closely monitored.

This type of access is inserted beneath the skin and is ideal for cancer patients who require regular doses of chemotherapy — usually about once every two to four weeks. It provides permanent access and consists of a catheter attached to a small reservoir implanted beneath the skin. A small bulge is visible where the reservoir is located. The catheter is inserted into the neck or shoulder and ends in the large central vein in the chest.