PICC or PORT Line for Chemo?

“To PICC or PORT, that is the question:” With apologies to the Bard of Avon, my topic today is to discuss some of the differences between a PICC line and a PORT for chemotherapy. 

A PICC is a Peripherally Inserted Central Catheter.  It is essentially an intravenous (IV) line that is inserted into a peripheral vein, typically in the upper arm, and advanced until the catheter tip terminates in a large vein in the chest near the heart to obtain intravenous access. It is similar to other central lines such as Central Lines or Ports as it terminates into a large vessel near the heart (the superior vena cava). However, unlike other central lines, its point of insertion is from the periphery of the body and usually a vein in the upper arm is the most common insertion point.

Unlike a standard IV line which is inserted in an arm or hand vein and terminates after only a few centimeters, A PICC line is usually inserted in the arm using ultrasound to guide the specially trained nurse or technician who is doing the insertion.  PICC lines differ from peripheral IV access but are similar to central lines in that a PICCs termination point is centrally located in the body allowing for treatment that could not be obtained from standard periphery IV access, such as chemotherapy, prolonged antibiotic treatment or TPN nutrition.  PICCs can also be used to draw blood samples.  PICC insertions are less invasive, have decreased complication risk associated with them, and can remain in place for chemotherapy use for up to 6 months, perhaps longer if properly cared for.  After the nurse or technician inserts the PICC, they may order a chest x-ray to confirm ideal placement. The entire procedure can be done in a patient’s room or a clinic exam room. 

The PICC may have single or multiple lumens.  A lumen is simply an access port with its own line that terminates in a junction prior to the point of insertion in the arm – think of a straw that has more than one mouth end prior to forming into a single tube before entering a milkshake!  Whether a patient has one or more lumens depends on how many intravenous therapies are needed.  The other feature of a PICC is that it needs to be flushed constantly with small amounts of heparin in order to keep the line from clotting.  The disadvantage here is that because of its placement on the arm, someone else has to be taught how to do this for the patient (unless you’ve got three functioning arms) as it is impossible to do oneself.  PICC Lines must be covered when showering and you really can’t go swimming with one in place.  I used Saran Wrap and cloth first aid tape to keep mine covered when showering.  I have heard others used Press N’ Seal or some variation of plastic wrap to keep theirs dry.

A Port (or Portacath®) is a type of central line that, like a PICC, has an intravenous line that terminates into a major vessel near the heart.  Unlike a PICC line though a PORT has a small reservoir which is under the skin and which is accessed by a special needle when a patient has to receive chemotherapy, TPN, blood products or have frequent blood tests.  The PORT reservoir is completely contained under the skin once implanted and therefore does not require flushing with heparin as often as a PICC line does.  A PORT has to be implanted by a physician under local anesthesia.  Also, one of the big advantages of a PORT is that once the incision heals, the patient can shower or swim without having to cover the PORT like they would with a PICC; nothing remains visible on the outside of the body.  Another advantage is that a PORT can stay in place for several years, whereas the realistic lifespan of a PICC line is usually 4-6 months. 

An alternative to a PORT is a Central line that is inserted in the chest and extends into a major vessel.  In this respect it is very similar to a PICC, except that the end of the line and lumen are on the outside of the chest, instead of on the outside of the arm.

I personally had a PICC line inserted first as it was the fastest way for my team to get me lined up for chemo late on a Friday afternoon;  The PICC, as you recall, can be inserted by a trained nurse.  I had my PICC for 4+ months and was having chemotherapy every 2 weeks.  I opted to have the port put in last December as it really offers much more freedom; for example, with the PICC I had to have a family member flush it with heparin solution every night and change the dressing at least once a week, more if I undertook heavy exercise.  I would also have to cover my arm in Saran Wrap as you cannot get a PICC insertion wet when showering.  PICCs limit your independence somewhat but if therapy is planned for a short time they will work well. 

When I had my PORT inserted, once the incision site healed after a few days I was able to shower and swim and the chemo nurse flushes it once every two weeks  when I was in for chemotherapy.  Pain after incision was minimal and anesthesia was an outpatient twilight sleep – Propofol (e.g., Diprivan®) or Midazolam (e.g., Versed®).  The chemo infusion insertion is with a special needle and I hardly feel anything, although if the thought of a needle piercing the skin makes you squirm the nurse can numb the area with a topical anesthetic first.  Every patient that I have talked to has commented they were so happy to get a port as it offered up much more flexibility and freedom than a PICC line.

The following web site has some excellent illustrations of the different types of central lines and PORTs described above:

http://www.cancerhelp.org.uk/about-cancer/treatment/chemotherapy/having/iv-chemotherapy#picc