Placement of access catheters / chemotherapy ports

Access catheters are long, thin tubes that are made of plastic. These catheters are placed directly in a large central vein, usually the subclavian vein (below the collar bone) and then connected to a subcutaneous 'port' which is easily palpable. This port can then be used to easily and painlessly administer the chemotherapy drugs.

Chemotherapy is the use of specific medications to treat or prevent the systemic spread of cancer. These drugs are mostly given by repeated intravenous injections and can be very toxic to small peripheral veins. In order to avoid repeated painful peripheral venous access/drip lines, it may be necessary to place an access catheter / chemotherapy port.

There are different types of access catheters used, and they are used for different reasons, depending on how long you may need cancer treatment, the type of cancer treatment you are receiving, how easily manageable the catheter is and the cost of the catheter.

Types of catheters:

• Central line tunnelled venous catheter, also known as the Hickman catheter:
  The surgeon will put this catheter in a large vein under the collarbone or neck vein. It will go under the skin, and the tip will normally be in your upper chest.
• A peripherally inserted central catheter (PICC):
  This catheter is put in a large vein near your elbow under local anaesthesia.
• Implantable chemotherapy port or “port-a-cath”:
  These ports are by far the most commonly used access methods. The surgeon will put in a “port“connected to a central line which will be palpable below the collar bone.

After the catheter has been inserted, to administer the chemotherapy drugs, the oncology sister will numb your skin with a cream and clean the skin. She will then put a needle into the port and administer chemotherapy drugs through the needle.

The most serious complications of access catheters / chemotherapy ports include:

• Port sepsis: once the port has become infected, it generally will need to be removed.
• Deep vein thrombosis of the arm: the catheter might cause a blood clot to develop in the arm. This will lead to a swollen arm and potentially necessitate the removal of the catheter.