PICC, Hickman and Port lines – Understanding Long-term Central Venous Catheters
Table of Content
Summary
Long-term Central Venous Catheters (CVCs), also known as central lines or ports, are thin, flexible tubes inserted into a large vein, typically in the neck, chest, or arm. They are essential for delivering medications, fluids, chemotherapy, blood transfusions, and nutrients directly into the bloodstream. They can also be used for frequent blood tests, reducing the need for repeated needle insertions. Long-term Central Venous Catheters are particularly useful for patients requiring long-term treatment, such as hemodialysis or intravenous antibiotics, or those with fragile veins unsuitable for regular IV lines. Common types include PICC lines, Hickman lines, and Port lines, each tailored to the duration and purpose of use. While highly effective, Long-term Central Venous Catheters require meticulous care to prevent complications like infections, blood clots, or mechanical issues. Proper maintenance, including regular flushing, dressing changes, and monitoring for infection, ensures that they can be used safely.
What are Long-term Central Venous Catheters?
A long-term central venous catheter is a thin flexible tube that is inserted into a large vein in the body. It is also sometimes referred to as a central line or a “port”. The long-term central venous catheter is usually connected through a vein in the neck, arm or chest. Some catheters have 2 or 3 tubes, allowing the patient to receive multiple treatments at once.
The long-term central venous catheter is a delivery mechanism for IV fluids, medication, chemotherapy and blood transfusions. They are also sometimes used to draw blood for testing purposes. A long-term central venous catheter helps reduce the number of times the patient needs to be injected with needles. If the doctor anticipates that multiple injections will be needed for many days in a row, they may choose to insert a central line. This reduces the patient’s discomfort and also saves time. The long-term central venous catheter can be left in place for months, or even years at a time.
Uses of Long-term Central Venous Catheters
Long-term Central Venous Catheters are useful for patients who need to undergo long-term treatments. This includes patients who need:
- Blood or platelet transfusion
- Chemotherapy
- Fluids or blood with rapid speed (For example, patients who may go into hypovolemic shock)
- Frequent blood tests
- Hemodialysis
- Long-term intravenous antibiotics
- Parenteral nutrition (nutrients delivered directly into the bloodstream, bypassing digestion)
A long-term central venous catheter is also useful for patients who have damaged veins from previous treatment and hence aren’t eligible for regular IV lines. This also applies to patients whose veins are too fragile or difficult to find.
Types of Long-term Central Venous Catheters
There are different types of Long-term Central Venous Catheters available. The type used depends on how long it will be required to stay in place, the purpose of the catheter and where in your body access is most convenient. This is something you can discuss with your family doctor or your health expert in detail. The different types of Long-term Central Venous Catheters are:
PICC
A PICC (Peripherally Inserted Central Catheter) line is a catheter that is placed in a large vein in the arm, usually above the elbow. The catheter is threaded through this vein to a location above the right atrium of the heart. The external end of the catheter may have 1 or 2 tubes called lumens, to provide intravenous fluids, medication and any other injectables the patient may need. The PICC line can be used for chemotherapy, blood transfusions, antibiotics, liquid nutrition and to draw blood for testing.
A PICC line is inserted as an outpatient procedure, in the radiology department. The patient will be made to lay down, and have a tourniquet fixed to their non-dominant upper arm. Ultrasound scans are used to carefully pick a large vein. The area around the vein is cleaned and then numbed with medication. Using the ultrasound guidance, the radiologist inserts a needle carefully into the chosen vein. A small incision is made in the vein so a thin catheter can be inserted. The catheter is then carefully moved along the vein, towards the heart. The placement of the catheter is verified using an X-ray. A cap is placed over the external end of the catheter to keep it clean. It may be taped to the arm to prevent it from getting in the way while the patient moves around.
The patient can expect some pain in the arm where the catheter has been inserted once the numbing medicine wears off. PICC lines can stay in place for up to 6 months when maintained properly, but most patients only need it for about 2 to 6 weeks.
Hickman Line
A Hickman line is a type of tunnelled long-term central venous catheter. This silicon catheter is inserted through an incision in the chest, and tunnelled under the skin until it reaches the target vein. It is then inserted into the target vein and manoeuvred towards the heart. The external end of the Hickman line may have 1, 2 or 3 lumens, to allow the patient to be given multiple medications or fluids at the same time. The external part of the Hickman line can easily be taped to the chest and hidden beneath the patient’s clothes. This way, the patient may go about their daily lives without anyone even noticing that they have a central line.
The Hickman line must be inserted by an interventional radiologist. It is a minor surgical procedure, performed under local anaesthesia. The patient lays down, and is covered in sterile drapes. The interventional radiologist chooses and appropriate incision site, and cleans it with antiseptic solution. Then, the patient is administered with local anaesthesia to numb the area. Two small incisions (approximately 4mm long) are then made. The first incision is made at the chest wall where the line exits the body. The second incision is made near the neck, around the collarbone where the line enters the vein. Between the 2 incisions, the line will “tunnel” under the skin. This procedure is performed under ultrasound fluoroscopy and an X-ray machine for accuracy and precision.
Hickman lines are preferred to PICC lines in certain cases where clotting is a concern. They are usually intended to be used for at least a month, and can be left in place for years. However, they must be maintained well.
Port Line
A Port line, also known as Portacath, is an implanted device placed below the skin. The Port consists of a small, flat metal or plastic disc, with a self-sealing silicone access point (called a septum) on top. A needle can easily pierce the septum to inject medication or draw blood. The port is connected to a catheter tube inside, threaded to a large vein near the heart. The entire Portacath setup is implanted under the skin in a minor surgery. You can feel a slight bump where the Port is placed below the skin. Port lines have low infection rates and can be used for many years. Port lines come in multiple variants – single lumen port, double lumen port and power-injectable port.
Inserting a port line is a minor surgical procedure that takes about an hour to perform. The patient is usually sedated during the procedure, to keep them calm. They are also given local anaesthesia around the chest and neck area, so they don’t feel any pain. The surgeon will make 2 incisions in the skin. The first incision creates a “pocket” under the skin for the port to be placed. It is usually about 3 to 4 cm long and located about 3cm below the collar bone. The second incision is smaller and located above the first incision. This is where the catheter enters the vein. The surgeon inserts the port under the skin and then threads the catheter through the vein towards the heart. They will verify correct placement using an X-ray. Once the port and catheter are in place, the surgeon will close the incisions.
Port lines can last for about 2000 punctures. That could take anywhere from 2 to 6 years depending on the patient’s treatment program.
Potential Complications from Long-term Central Venous Catheters
Long-term Central Venous Catheters are very useful in long-term patient care. However, we must be careful while using them, as they can cause the following complications:
Infections – Patients with Long-term Central Venous Catheters are prone to infections at the incision site. They could also develop bloodstream infections when bacteria enter through the central line. The risk increases if the patient has a PICC line, or multiple lumens. Patients must be careful and make sure they change their sterile dressings regularly, as well as keeping the insertion site dry.
Pneumothorax – A Pneumothorax is a collapsed lung. It is one of the most frequent mechanical complications caused by a long-term central venous catheter. This could happen accidentally during the insertion of the long-term central venous catheter. The patient may also face a risk of damage to the trachea or windpipe, bleeding and damage to an artery or vein during the long-term central line placement.
Thrombosis – Once the central line is placed, patients may develop blood clots around the catheter. These clots can break loose and travel to the heart, putting the patient at risk of stroke or heart attack. PICCs are associated with a greater risk of thrombosis compared to other types of Long-term Central Venous Catheters.
Air Embolism – Air embolisms are a potential complication that could occur during the removal of the central venous catheter, particularly if the catheter has been in place for a long time. An air bubble may accidentally get introduced into the blood stream, which could travel through the blood vessels towards the heart or the brain.
Caring for your Central Venous Catheter
It is important to take proper care of your long-term central venous catheter to avoid the complications mentioned above. Here are some good practices you can follow in the maintenance of your central line:
Flush the catheter regularly – Flushing the catheter regularly with saline solution keeps it clean and prevents blockages or blood clots forming inside the catheter. It needs to be flushed after every use, or as instructed by your interventional radiologist. The external side of the catheter also needs to be cleaned with alcohol wipes. Choose a time when you will not be distracted or rushed, as doing this process carefully is key.
Wash your hands – Always wash your hands well with soap and water before handling the central venous catheter.
Change the dressing – The sterile dressing on the long-term central venous catheter needs to be changed regularly. The doctor and nurses will give you detailed instructions on how this needs to be done. It is also important to make sure the dressing stays dry when you shower. You can get a watertight cover to protect it.
Check for signs of infection – Each time you change your dressing or flush the catheter, it is good practice to check the insertion site for any signs of infection. This includes any redness, swelling, pus, or fluids leaking from the site. If you observe any of these signs, inform your doctor immediately.
Tape the Catheter securely – Ensure the catheter is always taped securely in place. The catheter should not move as you perform daily activities. If the external end is left free, it can get caught on things around you and get pulled out of place.
Call your doctor at the first sign of trouble – If you develop a fever, chills, aches, dizziness or nausea, call your doctor immediately. These are potential signs of a blood clot forming around the catheter. This needs to be investigated as early as possible to prevent fatal complications.
Discover more about your health and wellness at Kauvery Hospital. With branches located in Chennai, Hosur, Salem, Tirunelveli, and Trichy, our team of experienced medical professionals are dedicated to providing advanced care and treatment, tailored to individual needs. Visit us today and enhance your journey towards optimal health and well-being.
Frequently Asked Questions
What is a long-term central venous catheter?
A long-term central venous catheter is a thin tube inserted into a large vein (usually in the arm, chest, or neck) to deliver medications, fluids, or nutrition directly into the bloodstream over an extended period.
What is the PICC line used for?
A PICC line is a long, thin tube inserted into your arm, often used for extended IV treatments like antibiotics or chemotherapy.
What’s the difference between a Hickman line and a Port?
A Hickman line is a tunneled catheter inserted into the chest or neck, while a Port is an implanted device under the skin for easier, long-term access.
How long can a central line stay in place?
A PICC line stays in for weeks to months, while a Hickman line can last months, and a Port can remain for years with proper care.
Is there a risk of infection with central lines?
Yes, there is a small risk of infection. Proper care and hygiene reduce the chances of complications.
How do I care for my central line at home?
Keep the site clean and dry, flush the line regularly, and check for signs of infection. Follow your doctor’s instructions carefully.
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