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Venous Access and Implantable Ports

Venous Access and Implantable Ports

Many conditions require treatment needing reliable access to the bloodstream via veins eg cancer, blood disorders such as sickle cell disease & haemophilia and chronic disease eg cystic fibrosis, enzyme deficiences. This allows regular intravenous therapy to be administered such as chemotherapy, blood & related products and also facilitates frequent blood sampling without damaging valuable veins and causing distress.

Although ‘peripheral’ cannulas can be used for this purpose, they cannot be left in place for more than a few days. A number of devices however are now available. A peripherally inserted central venous catheter (PICC) is typically inserted at or just above the elbow and allows a ‘long line’ to be inserted into a peripheral vein and manipulated unto a central vein above the heart. These catheters are inserted under local anaesthesia and can stay in the vein for many months. In Guildford, The Imaging Clinic Radiologists have been inserting PICCs for over 10 years with a tremendous success rate and few complications.

Some patients find PICCs rather awkward as they can slightly limit bending of the elbow and as they are visible all the time, they may serve as a constant and distressing reminder of the underlying illness such as cancer. An alternative device is a more ‘centrally’ place device such as a Hickman/Broviac or Groshong catheter. The latter is valved and offers some advantages in most patients in preventing catheter blockage whilst the former is preferable when more channels are required or a higher flow rate is necessary to administer therapies. The Hickman line is typically larger and more bulky than the Groshong catheter and are preferred for patients undergoing bone marrow or other transplants.

These‘central’ catheters are very popular with patients and The Imaging Clinic has had a 100% success rate in inserting them for more than 10 years with barely any complication and none significant. In the operating room, typically under mild sedation and using local anaesthesia, the internal jugular or subclavain vein is entered under ultrasound guidance and the catheter manipulated into the superior vena cava or right atrium under x-ray control. These catheters contain a‘cuff’ which remains hidden under the skin and this helps prevent catheter dislodgement.

For a number of years, patients receiving treatment such as chemotherapy for 3 months or more have been referred for insertion of a Portacath. The method of insertion is similar to the procedure for other ‘central’catheters. However, instead of leaving the catheter end or ends protruding from the chest wall, the catheter is connected to a small just palpable chamber and implanted just below the skin of the chest wall so that the chamber can be accessed ‘by feel’ but is barely visible to the patient or others. Our clinic has been inserting these devices for over 10 years with a 100% success rate with no significant complication.

All of these devices allow home administration of products such as cancer drugs facilitating ambulatory outpatient therapy rather than hospital admission. They are all easily removed and can be repaired or replaced on the very rare occasions when function is impaired.

Other venous devices are also inserted by the clinic including haemodialysis catheters and Denver Peritoneovenous shunts. The Clinic also supports problems with any of these devices inserted outside Guildford and can help in the Interventional radiological management of thrombosed dialysis fistula grafts.

Patients are encouraged to discuss their  requirements before choosing a devise which will best suit them. Please call 01483 801010 for a consultation