PICC

PICC stands for peripherally inserted central catheter. As with a line, the end comes out of the skin, but this time in the elbow.

PICCs are put in at the bedside under local anaesthetic. This is relatively quick and simple as well as cheaper than a line. For this reason, they have become very popular in America, but they do have limitations.

Not everyone is suitable for a PICC. A PICC can only be inserted into one of the two major veins in the elbow. Although I use ultrasound to locate these veins, people with swollen arms or poor veins are not suitable. If you have had blood samples taken from your elbows, the veins are likely to be unusable. Even if none of this applies, I cannot guarantee you will be suitable until I have examined you, so you may then need to come back for a Groshong.

A PICC is normally inserted without X Ray screening, and an X ray is then taken to check its position. It may then be necessary to relocate it but this is painless.

A PICC has a lower risk of infection than a Groshong, but it also has a shorter expected life (weeks compared with months). It is ideal for a few weeks.

Some people prefer a line on their arm as opposed to their chest. You do not need to keep your elbow straight, but the same care is needed to avoid pulling it out.

 

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Choosing whether to have a line or port

The difference between a line and a port is not great. You may wish to be guided by your oncologist, and in some cases only one particular system will be suitable for an individual patient. This page will describe the different systems currently in use:

Groshong line

All three systems involve a plastic tube that is placed in a large vein in the chest. In the case of a Groshong line, the end of the line comes out just above the breast and terminates in an injectable bung or stopper. The external part of the line is secured under a plastic dressing and there is a small clip attached to the skin by a couple of stitches.

This type of line is the most common system in the UK and can be used for most patients. If you have a haematological malignancy such as leukaemia I will use a Hickman line which facilitates higher flow rates but is basically the same. The other two systems will be compared against these lines.

Ports

Instead of bringing the line out of the body, we connect it to a small metal chamber under the skin. In the past these were big and heavy, but I have recently introduced small lightweight ports that patients are unaware of. Except in very thin patients, nobody else can see the port.

When a port is used, local anaesthetic cream is placed on the skin, and a needle is then passed through the skin into the chamber. The system works exactly the same as a line. The needle normally has a short length of tubing attached and is left in until that episode of treatment is completed (up to two weeks if necessary).

The metal used is titanium, which does not set off metal detectors at airports or prevent you having an MRI scan.

A comparison

A port requires a cavity to be created under the skin. This is no more distressing than having a line inserted, but there will be a wound about an inch long just above the breast. Most heal well, but there will be more of a permanent mark than with a line which leaves only a circular mark like a mole.

Most people choose a port because of body image: they do not like anything coming out of their body. It is also advantageous if you play sport or are otherwise active because it cannot be pulled out accidentally.

Ports are less likely to get infected and are ideal for very long term treatment, especially if treatment is intermittent. However, because there is a wound, there is a higher incidence of wound infection at the time of insertion (up to 7% in the UK) and even if there is no infection the port area may initially be tender and swollen so painkillers are needed for a few days.

A port needs no maintenance from the patient, whereas we insist patients flush and clean their own lines. A port still needs flushing, probably every two to four weeks, which will require you to come into contact with a suitably trained nurse. A port may not be suitable if you plan long term travel therefore. However, you can swim and bathe with a port with no risk of infection.

A port involves needles, so is not ideal if you have a needle phobia. Finally, although there is no evidence showing it must be removed, most people do want it removed after treatment and this involves opening the wound again.

A port is more expensive, which may be relevant to you.

If by now you cannot make up your mind, do not worry. The difference is not great, and I would suggest you choose the Groshong line. If however you wish to discuss it further, please contact me and I will be happy to give you further guidance.

 
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