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Overview
Long-term vascular access is most frequently requested for people requiring long-term chemotherapy. Although these medications can be given in the peripheral IV (in the hand), the veins are often burned by the chemicals, making IV access difficult. Technology has advanced such that larger IVs can be placed closer to the trunk of the body to prevent this scarring. Other reasons for these options to be utilized would be for long term IV antibiotics in someone with infected bones, or a need of frequent blood transfusions, frequent blood draws, or unusual medications that can only be provided in the vein. These are placed at the hospital under x-ray guidance. They are performed as an outpatient with some simple IV sedation and local novocaine.
Port-A-Cath
The Port-A-Cath is a walnut-sized titanium port that lies usually in the left chest under the skin and can then be accessed through the skin via a needle. This is the avenue that is most popular with patients. When it is not in use, there are no external catheters and is almost invisible under the skin. It allows for unlimited activites (i.e. showering, swimming, ...). It also has a lower infection rate. The procedure is done under x-ray guidance to confirm appropriate placement into the vein below the collarbone (clavicle). These must be flushed once a month to prevent clotting and removal is a simple office procedure. They can last several years if maintained appropriately. Approximately 80% of the time, blood can be removed through the port for patients with frequent lab draws associated with monitoring the effects of chemotherapy. The risk of placement is minimal, although a small amount of bruising is expected. In addition, there is a 1% chance of puncturing the lung during insertion which would require observation in the hospital for several hours. This rarely requires further treatment.
Groshong
The Groshong is up to three IVs combined into one tube with these IVs hanging outside the chest wall. Similar to a Port-A-Cath, it is tunneled under the skin and placed under the clavicle into the central system. Placement is similar to that of a Port-A-Cath and is removed in the office. The indications for this approach would be someone who needs frequent access (daily) for a short period of time, since removal is slightly easier than a Port-A-Cath. The complications are the same.
Peripherally Inserted Central Cather
A PICC line is typically inserted by the Anesthesia Department and is available through the Pain Clinic at Kishwaukee Hospital. This is usually placed in the elbow and tunneled up through one of the larger veins in the arm. Because it is much smaller, there is a higher rate of clotting of these catheters. However, they are very comfortable. It does require the IV to be left outside the arm. There is minimal risk of infection. There is no risk of punctured lung.
Triple Lumen Cather
Triple lumen catheters are placed without fluoroscopic guidance into the central venous system. They are considered temporary (5-7 days) and therefore are usually only recommended for patients in the hospital who require multiple IV's, mulitlple different medications, blood products or IV nutrition (TPN), or individuals who have poor veins for regular IV's.
Summary
These can all be inserted as an outpatient, and depending on your medical needs, your surgeon will advise you as to the most appropriate option.
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