If you need to receive medicine or fluid intravenously (IV) on an occasional basis, a simple standard drip IV in a small vein in your arm is usually sufficient (this is called peripheral venous access). However, sometimes, you may need drugs to support your heart, special antibiotics, chemotherapy (or other) drugs, or IV nutritional support for an extended period. In these situations, it may beneficial for your doctor to have ready access to a major vein.
Central venous access (also called central line placement) is a safe and easy way for patients to receive intravenous fluids without the trauma of repeated needle sticks. You can continue your normal activities and, in some cases, even receive your IV medications at home. Central Venous Access also makes it convenient when you have to have blood drawn frequently to see if your disease is progressing or how you are responding to treatment.
There are different types of catheters used for this type of access. Some of these devices are designed to be used only while you are in the hospital. Others are made for use outside the hospital and some are implanted under your skin (ports) and can be used for years. Even other catheters are specially designed to allow for dialysis to be performed through them. Depending on your needs, and after a thorough discussion with the physician who requested the central venous access, we will recommend what is best for you. Usually, we use one of three veins for central venous access: the jugular vein in the neck, the subclavian vein below the collarbone, or one of the veins in the arm.
What happens during Central Venous Access or port insertion?
You will have already discussed the treatment options with the physician or his assistant doing the procedure. When it’s time to begin, we’ll take you to a special room that is similar to an operating room. We often use local anesthesia for minor catheter insertions, so you will be aware of the rest of the procedure. If you need a port insertion, you’ll receive conscious sedation, or moderate anesthesia. You’ll be comfortable, but remain slightly awake throughout the procedure. We will monitor your pulse, blood pressure, and your breathing throughout the procedure.
During the procedure, you’ll lie on your back on a table and we’ll clean the area where the catheter (a thin, hollow tube) will enter your body using a special solution to minimize infection. We’ll place sterile drapes over your body and an interventionalist will apply a local anesthetic so you don’t feel any pain.
Your interventionalist will insert a tiny guide wire and, using ultrasound or x-rays, or both—possibly with a contrast material—will guide the wire to a central vein next to the heart. Then the interventionalist will use the wire to place a catheter in the vein, securing the end of the line to your skin with a stitch and dressing. When inserting a port or “portacath,” your interventionalist will make a small cut along your chest and create a pocket under the skin for the port to fit into. Then, we’ll close the cut with special dissolving stitches under your skin. A dressing will be applied.
After the central venous access procedure, whenever you need to receive IV fluids or medications, your doctor or nurse will attach the drip bag to the external end of the central venous access, in the case of a port place, a special needle will be placed into the port, finally in the case of dialysis the catheter will be connected to a dialysis machine.