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Vascular Access

(Port Placement & Picc Line)

In a Vascular Access procedure, such as Port Placement, the insertion of a flexible thin plastic tube, or catheter, into a blood vessel provides a painless way of drawing blood or delivering drugs and nutrients into a patient's bloodstream over a period of weeks, months or even years.

Your doctor may recommend a Vascular access procedure for:

  • Intravenous antibiotic treatment
  • Chemotherapy, or anti-cancer drugs
  • Long-term intravenous (IV) feeding for nutritional support
  • Hemodialysis, a process used to treat patients whose kidneys are not working properly. It involves a special machine and tubing that removes blood from the body, cleanses it of waste and extra fluid and then returns it back to the body.

    Your doctor may recommend an Access catheter for:

    • Blood transfusions
    • Patients who have difficulty receiving a simple IV line

    Prior to your procedure, your blood may be tested to determine how well your liver and kidneys are functioning and whether your blood clots normally. You may be instructed not eat or drink anything for several hours before your procedure. You should plan to have a relative or friend drive you home after your procedure. You may be asked to remove some or all of your clothes and to wear a gown during the exam. You may also be asked to remove jewelry, eye glasses and any metal objects or clothing that might interfere with the X-ray images.

    In this procedure, X-ray and ultrasound equipment, a vascular access catheter, a venous access needle and a guide wire are used. The X-ray equipment allows the operator to watch the wire and catheter on a live display so they can be inserted safely and positioned to optimize catheter function. Ultrasound is used to assess the vein that is being used for catheter placement and to provide guidance during the venous puncture.

    Following are the major types of Vascular Access catheters:

    • The peripherally Inserted Central Catheter (PICC) is a long catheter that extends from an arm vein into the largest vein (superior vena cava) near the heart and typically provides central IV access for several weeks, but may remain in place for several months.
    • The port catheter, or subcutaneous implantable port, is a permanent device that consists of a catheter attached to a small reservoir, both of which are placed under the skin similar to tunnel catheters.

    Other vascular access procedures are most often performed by a specially trained interventional radiologist in an interventional radiology suite or occasionally in the operating room.

    These procedures are often done on an outpatient basis:

    • PICC: To place a PICC line, the physician will identify the vein using ultrasound or x-ray guidance and insert a small needle into the arm vein and advance a small guide wire into the large central vein, called the superior vena cava, under x-ray (fluoroscopy). The catheter is then advanced over the guide wire and moved into position. The guide wire is then removed.
    • PORT-CATHETERS: Implanting a subcutaneous port generally requires two incisions.

    The port reservoir is placed under the skin following a small skin incision and creating a small subcutaneous pocket. The incision for the port is usually about two inches long. A small, elevated area remains on your body at the site of the reservoir. The port, which passes from an access site in a vein of your arm, shoulder or neck, ends in a large central vein in the chest. The reservoir has a silicone covering that can be punctured with a special needle.

    Incisions are held together by stitches, surgical glue and/or a special tape. An X-ray may be performed after the procedure to ensure the catheter is positioned correctly. Your intravenous line will be removed. The implanted vascular access catheter is then ready for use.

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