A Look a Venous Access Procedures

If you are undergoing treatment for infections requiring antibiotics, anemia requiring iron infusions or blood transfusions, or chemotherapy, your doctor may order a central venous access catheter (CVAC) or peripherally inserted central catheter (PICC) to be placed in your veins. Venous access procedures provide doctors with a way to readily reach some of your central veins without the need to start frequent IV lines in your arm or hand.

Reasons for Venous Access Procedures

A central venous access catheter (CVAC) is a tube that is inserted beneath the skin and into a major vein, typically in the chest. It allows doctors and nurses to draw blood or administer medications and nutrients easily, quickly, and without causing the patient any pain. CVACs are a way for you to avoid the discomfort, bruising, and irritation caused by multiple injections. A PICC line is inserted into a smaller vein in the upper arm and the tube continues through the vein into a larger vein in the chest. A port-a-cath is a central venous access catheter that has a reservoir that is implanted just under the skin in the upper chest. No tube is visible from the skin. These catheters are often used for patients who are undergoing chemotherapy or dialysis treatments, or for those who require frequent supplement, antifungal, or antibiotic infusions.

Process for Venous Access Procedures

Your CVAC will be placed by an interventional radiologist. You may be given medication to help you relax, and the area around the site will be numbed. Next, a needle will be inserted into the venous access point to create a tunnel into which the CVAC will be placed. The tip of the central venous access catheter reaches into a large vein, and the other end remains outside your skin. In the case of a port-a-cath, a small chamber containing a silicone septum is connected with the tube in the vein and placed just under the skin in the chest or in some cases in the arm. Patients may feel slight discomfort and pressure during the procedure. To prepare for your CVAC, your nurse or doctor will provide you with instructions. Your doctor may tell you to consume only clear liquids after midnight on the night before your procedure.

What Is a Venous Access Procedure?

Every IV starts with a needle in a vein. For a short hospital stay, a small catheter in the hand or forearm works well. But when treatment lasts weeks or months, or when the medicine is irritating to small veins, those small IVs become a problem. They stop working after a few days, the veins in the arm become bruised and scarred, and each new stick is harder than the last.

A venous access procedure solves this by placing a longer catheter whose tip sits in a large central vein near the heart, where blood flow is high enough to dilute strong medicines immediately. The catheter can stay in place for the length of treatment, and the nurse uses it for infusions and blood draws instead of finding a new vein each time. Interventional radiologists place these devices every day, and the procedure is one of the most common in the specialty.

Types of Venous Access Devices Compared

The previous sections introduced CVACs, PICC lines and port-a-caths. Each has strengths and trade-offs, and choosing the right one depends mainly on how long you need it, how often it will be used and your daily lifestyle.

Your oncologist, infectious disease physician or nephrologist usually decides which treatment you need, and the interventional radiologist helps choose the device that fits that plan and your veins. You can read more about ports on our port-a-cath placement page.

Who Needs Venous Access?

Beyond the reasons already described above, venous access is commonly used for:

• Cancer treatment that involves repeated chemotherapy, immunotherapy or supportive infusions
• Long courses of IV antibiotics for bone, joint, heart valve or other deep infections
• IV nutrition when the digestive system cannot absorb enough food
• Repeated blood transfusions, iron infusions or plasma exchange
• Hemodialysis, either temporarily or while a fistula or graft matures
• Patients whose arm veins have become very difficult to access after years of treatment

How We Plan Your Venous Access Procedure

At Premier Vein & Vascular Center, Dr. Syed Raza, a fellowship-trained interventional radiologist, plans each device around your treatment and your veins.

1. Review of your treatment plan. We confirm with your referring physician what will be infused, how often and for how long, since that determines the best device and catheter type.
2. Focused history. We ask about previous lines or ports, blood clots, pacemakers, breast or chest surgery, radiation, allergies to contrast or numbing medicine, and which arm you use most.
3. Vein assessment. Ultrasound is used to check that the target vein is open and a good size. If you have had many previous lines or clots, additional imaging may be needed to map a clear route.
4. Medication and lab review. We check blood counts and clotting tests when needed and tell you whether to pause any blood thinners, and for how long.
5. A clear plan. We explain which device we recommend, where it will sit, how it will look and feel, and how to care for it.

Questions to ask before your procedure

• Which device do you recommend for my treatment, and why?
• Will it be in my arm or my chest, and which side?
• Can it be used for blood draws as well as infusions?
• Who will flush and care for it, and how often?
• Do I need to stop any of my medications beforehand?
• Will I need someone to drive me home?

Writing these down and bringing them to your appointment helps make sure nothing is missed, particularly when you are also adjusting to a new diagnosis or treatment plan.

What Happens on the Day of the Procedure

Patients are often surprised by how routine the procedure feels. After check-in, a nurse places a small IV and you may receive medicine to help you relax. The skin is cleaned and numbed.

Using ultrasound, the interventional radiologist watches the needle enter the vein in real time. This is one of the main safety advantages of image guidance: it avoids blind needle passes and nearby arteries. A thin guide wire is passed into the vein and X-ray (fluoroscopy) is used to steer the catheter so that its tip sits in exactly the right place near the heart. For a port, a small pocket is made under the skin of the upper chest to hold the reservoir, and the incision is closed with dissolvable stitches or skin glue.

A PICC line usually takes well under an hour. A port or tunneled catheter typically takes about an hour from start to finish. After a short recovery period, most patients go home the same day. In many cases the device can be used right away, which means your treatment does not have to be delayed. More details are on our venous access page.

Living With a PICC, Catheter or Port

The first few days

It is normal to feel some soreness, bruising or tightness at the insertion site for a few days. Simple pain relievers and an ice pack (wrapped, not directly on the skin) usually help. Avoid heavy lifting with the affected arm or strenuous upper body exercise for about a week, or as instructed.

Everyday care

• Keep external lines dry. PICC lines and tunneled catheters must be covered when showering, and baths, hot tubs and swimming should be avoided.
• Dressing and flushing. External lines need regular dressing changes and flushes, usually weekly, by a nurse or a trained family member.
• Ports need less upkeep. Once the incision heals, a port needs no dressing between treatments and is flushed periodically, often when you come in for treatment.
• Protect the arm with a PICC. Avoid blood pressure cuffs and tight sleeves on that arm, and avoid very repetitive heavy arm use.
• Carry your device card so other providers know what type of device you have.

Possible Complications and Warning Signs

Venous access procedures are low risk, especially when performed with image guidance, but no procedure is completely free of risk. The problems we watch for include:

• Infection at the skin site, in the port pocket or in the bloodstream
• Blood clots in the arm, neck or chest vein around the catheter
• Catheter blockage, when the line will not flush or draw blood
• Catheter movement, when an external line slips out partway or the tip shifts
• Bleeding or bruising at the insertion site
• Rarely, an air leak around the lung when chest veins are accessed, which is much less common with ultrasound guidance

Many of these problems can be fixed without removing the device, for example with a clot-dissolving flush for a blocked catheter. Reporting symptoms early makes a big difference.

Removing the Device When Treatment Ends

Once your treatment is finished, the device is removed. A PICC line is usually taken out at the bedside or clinic in a few minutes without any incision. A tunneled catheter is removed after numbing the skin, usually with a small incision to free the cuff that held it in place. A port is removed through a small incision over the reservoir under local anesthesia, typically in a short office procedure. Some patients keep their port for a period after treatment if their oncologist wants it available for follow-up blood tests.

Venous Access in Houston: When to Ask Your Doctor

If you are about to start chemotherapy, a long course of IV antibiotics or another infusion treatment, it is worth asking your physician early which venous access option suits you, before arm veins become damaged by repeated IVs. Dr. Syed Raza has more than 15 years of experience as an interventional radiologist and is a former Chief of Interventional Radiology at UTMB Galveston and Memorial Hermann Memorial City. Our team at Premier Vein & Vascular Center in Houston works with referring oncologists and specialists to place ports and lines promptly, and supports patients through oncology care and other long-term treatment. Most insurance plans, including Medicare, are accepted.

Frequently Asked Questions

Is a port better than a PICC line?

It depends on how long you need access and how often. A PICC line suits treatment lasting weeks to a few months, while a port is usually preferred for long-term, intermittent treatment such as chemotherapy because nothing is outside the skin between uses and infection risk is lower over time.

Are you awake for port placement?

Most patients receive local anesthesia to numb the area and light sedation to stay relaxed and comfortable. Many are drowsy but able to respond, and they go home the same day with a driver.

Does a port hurt when it is accessed?

Accessing a port feels like a quick needle stick through the skin over the reservoir. Some patients use a numbing cream beforehand, and most find it much easier than having a new IV placed each time.

Can you shower with a PICC line?

Yes, but the line and dressing must stay completely dry, usually with a waterproof cover over the arm. Swimming, baths and hot tubs should be avoided while the PICC is in place.

How long can a port stay in?

Implanted ports are designed for long-term use and can remain in place for months to years as long as they work well and are flushed regularly. Your care team will decide when it is no longer needed.

Can I exercise with a port or PICC line?

Light activity such as walking is encouraged. Avoid heavy lifting and strenuous upper body exercise for about a week after placement, and with a PICC, avoid repetitive heavy use of that arm for as long as it is in.

Can a port set off airport security?

A port is small and usually does not trigger airport metal detectors, but it may show up on body scanners. Carrying the device card you receive after placement makes it easy to explain if questions come up.

Trusted Health Resources

1. Chronic Venous Insufficiency, Society for Vascular Surgery
2. Venous Insufficiency, MedlinePlus Medical Encyclopedia (NIH)
3. Varicose Veins and Spider Veins, MedlinePlus (NIH)