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About Lymphoma

Central venous access devices

Central venous access devices (CVAD) are intravenous catheters that can stay in place for weeks, months or in some cases years. There are different types of CVADs, and this page will discuss some of the most common ones you might me offered.  They are used to deliver your treatment straight into your blood stream (intravenously) and are an alternative to having a cannula. 

CVADs are inserted in different ways, but the end of the catheter always sits in a large vein just above your heart.

The following are some of the reasons you can ask for, or may be offered a CVAD.

  • You are having treatment for more than 3 months
  • You need to have lots of medicine or fluid given in a short time
  • You are having medications that may cause damage to smaller veins
  • You are having an apheresis procedure (such as to collect stem cells)
  • You have difficult veins to cannulate
  • You are severely afraid of needles.
On this page:

Types of central venous access devices

  • Peripherally Inserted Central Catheter (PICC)
  • Non-Tunnelled Catheter (CVC)
  • Tunnelled Central Venous Catheter (Hickman)
  • Implanted Port (Port-A-Cath)

Above: Peripherally inserted central catheter (PICC)

Peripherally inserted central catheter (PICC)

A PICC line is a soft, small, long, hollow tube (catheter) that is placed into a large vein in your upper arm just above the bend of the elbow. It is gently pushed up through the vein inside your arm and the end of it stops in a larger vein just above your heart.

A PICC line can be put in (inserted), in the radiology department, operating theatre, at your bedside while in hospital, or a procedure room. You will likely be given a local anaesthesia before they insert the PICC to numb the area, so you should not have any pain. PICC lines can be inserted by your doctor, specially trained nurse or a radiologist, depending on the policies at your hospital.

You can ask for a PICC lines, or it may be offered to you if you are having treatment that is expected to last more than a week, but less than 6 months. If your treatment is expected to last more than six months a different CVAD may be offered.

You cannot swim with a PICC or put the PICC underwater.  You will also need to keep it covered when you shower. Your nurse will be able to give you more information on how to manage with the PICC at home.

Management

  • You will need to have the PICC redresses and the bungs changed at least once per week. This is usually done at the day unit or on the ward if you are in hospital. In some cases, the nurse may be able to do the dressing and bung change at your local GP – though this is not offered routinely and not all practice nurses are trained in managing PICCs.
  • Your PICC will need be to flushed at least once per week if you have not had any medicine or other fluids through it.
  • If you do not need the PICC anymore, it can be removed by trained nurse in the day care unit or ward. 

Totally Implantable Venous Access Device (TIVAD)

 

A totally implantable venous access device (previously called a port-a-cath) is a device inserted under your skin into a subcutaneous (fatty) pocket. The TIVAD has a reservoir which can be felt under your skin. The catheter is then inserted into one of your large veins. It is used when you need medicines intravenously – into your veins or blood stream.

When is a TIVAD a good option?

A TIVAD is a good idea if you are going to be having treatment for more that three months, or if your healthcare team has trouble putting a cannula into your vein.  When you need to have medicine  or a blood test, your nurse will put a needle through your skin and into the reservoir. You will have a small dressing over this while it has the needle in. Once the medicine has finished going through, they will take the needle out. The needle can stay in for up to 7 days.

When you have a needle in the TIVAD it is said to be accessed. When there is no needle in the TIVAD is is deaccessed. You can still swim and shower as normal when your TIVAD is deaccessed, but you cannot swim while it is accessed. You will also need to keep it covered in the shower while it is accessed.

A TIVAD is inserted by a surgeon or an interventional radiologist under anaesthesia or light sedation.
It usually takes around 7-10 days to heal. If the port needs to be used immediately, the surgeon can access it and leave the needle in when it is put in. Otherwise it may be too swollen to access for about a week.

Patient experience with a port-a-cath (TIVAD)

 

Hear Venuja talk about her experience with a TIVAD (port-a-cath) while in hospital.

Management of a TIVAD

  • When the TIVAD is needed to be accessed, it is done so with a needle called a ‘gripper’ needle
  • A gripper needle can remain in for one week before they need to be changed
  • Once your treatment cycle has finished and the gripper needle is removed (your TIVAD is deaccessed)
  • The best thing about a port is that they can remain in for many years and once the gripper needle is removed there is nothing hanging from the port and your skin protects it from infection
  • When a port is removed, this is a surgical procedure (day procedure).
While your TIVAD is deaccessed, if you are not having any treatment through it, you will still need to have appointments every 4-6 weeks to have it flushed. This helps to keep it free of any clots so that it continues to work effectively when it is needed. 

Non- tunnelled central venous catheter (CVC)

Non-tunnelled central venous catheters (CVCs) are short term catheters and should be removed as soon as they are no longer required.

Non-tunnelled CVCs can be inserted into the subclavian, or jugular veins in your neck or femoral veins in your groin – though the femoral vein is more commonly used for children.  Regardless of which vein the CVC is put into, the end tip is positioned in the superior or inferior vena cava – a large vein just above your heart. 

The CVC is held in place with either stitches or or a special clamp that is attached to your skin. The picture below shows a non-tunnelled CVC with three lumens, held in place with stitches.

Management

  • Dressings and caps on the lines need to be changed at least once per week
  • Each lumen of the line needs to be flushed once per week
  • They can easily be removed by being pulled out once there is no further use for them

Tunnelled cuffed-centrally inserted central catheter (tc-CICC)

You may need a tunnelled cuffed – centrally inserted central catheter (tc-CICC) if you are going to intravenous medicines long-term. 

A tc-CICC is a central line catheter that is placed on the right side of your chest wall. It is a soft, small, long, hollow catheter that is placed into a vein in your chest and ends in a larger vein just above your heart. 

Types of tc-CICC

The main types of tc-CICC used in Australian are HICKMANs and Broviacs. THey can be a single (1), double (2) or triple (3) lumen catheter. The picture above shows what a double lumen HICKMAN looks like. 

When the tc-CICC is first put in, you will have some stitches holding it in place and a dressing over the top. There is a little cuff on the catheter that sits under your skin, and your skin grows over the top of this cuff making a little tunnel under your skin. Once the tunnel has developed properly you may or may not still need a dressing over the top. 

A tc-CICC is inserted by a surgeon or an interventional radiologist under anaesthesia or light sedation. It will usually take 7-10 days to heal.

Management

  • This will depend on the policy at the hospital your are being treated at.
  • They usually need to be flushed one per week.
  • Caps on the end of the line generally need to be changed at least once per week
  • When you no longer need your tc-CICC it will be removed. Your doctor or nurse will assess you and the line before it is removed to determine the best way to remove it.  It may be removed in the day care unit, radiology department or an operating theatre.

When to contact your doctor

Contact your doctor or nurse if you have:

  • A temperature of 38 degrees or higher
  • Shortness of breath
  • Chest pain or fast heartbeat
  • Redness, pain, swelling, bleeding, or fluid leaking from or around your CVAD
  • Redness, pain or swelling in your arm, neck, or chest area
  • Damage or a break or split in the PICC line or CVC line
  • A burning sensation or swelling around your CVAD during your treatment, or at any time.
For more info see
Treatment through a peripherally inserted central catheter (PICC)
For more info see
Treatment through a portacath (totally implantable venous access device TIVAD)
For more info see
Treatment through a tunnelled cuffed - centrally inserted central catheter (tc-CICC)

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