What is vascular access?

“Vascular access” simply means a reliable way to deliver medications and fluids into your bloodstream and to draw blood for testing — without sticking your arm every time. The right kind of access depends on what you need, how long you’ll need it, and your everyday life. The most common options are:

• Chemotherapy port (also called a Port-a-Cath, Mediport, or PowerPort) — a small reservoir, about the size of a quarter, placed under the skin of the upper chest and connected by a thin, soft tube to a large vein near the heart. It lives quietly under the skin between treatments. When it’s needed, your nurse places a small needle through the skin into the port. Modern ports are power-injectable, meaning they can also be used for CT scans with contrast.
• PICC line (peripherally inserted central catheter) — a long, thin tube placed through a vein in the upper arm and threaded to a large central vein near the heart. Part of the line stays outside the arm under a small dressing. Used most often for several weeks of IV antibiotics or shorter courses of treatment.
• Tunneled central venous catheter — a Hickman, Broviac, or Groshong catheter that exits through a small skin tunnel on the chest. Used for prolonged chemotherapy, IV nutrition, or stem cell collection.
• Tunneled hemodialysis catheter (sometimes called a PermCath) — a larger tunneled catheter used for dialysis when an arteriovenous fistula or graft is not yet ready or is no longer working.

Why image guidance matters

Decades ago, central lines were placed using surface landmarks alone — the doctor felt for a pulse and pushed a needle through skin into a vein they couldn’t see. National practice guidelines from the Society of Interventional Radiology, the Association for Vascular Access, and the Infusion Nurses Society now recommend image-guided placement for the same reason airlines use instrument landings — it is more accurate, safer, and produces fewer complications.¹² At FIS, every placement is performed under live ultrasound for the vein puncture and live X-ray for catheter tip position. Most placements are successful on the first attempt.

Port or PICC — which is right for you?

The most common question patients ask. The answer depends on how long you’ll need access and how active your daily life is.

• Choose a port when treatment will last several months or longer (chemotherapy is the classic example), you want access hidden under the skin between treatments, you want to shower, swim, and exercise normally, and you’d rather come in for a quick monthly flush than care for a dressing every day.
• Choose a PICC when treatment will last a few weeks (most often four to six weeks of IV antibiotics for a serious infection), you want fast placement and removal without an incision, and you have help at home with daily dressing care.

Your oncology, infectious-disease, nephrology, or referring team will guide the choice.

What the day looks like

You’ll arrive about an hour before the procedure for paperwork and an IV. Most patients have light sedation along with a local numbing medication. The procedure itself takes 30 to 60 minutes. You’ll feel pressure but not sharp pain. After a short recovery — usually under an hour — you’ll go home the same day. Most patients have only mild soreness for a few days, and the access can typically be used right away.

Dialysis access maintenance

For patients on hemodialysis, an arteriovenous fistula or graft is the preferred long-term access — but it occasionally narrows or clots and needs maintenance to keep working. We perform fistulagrams (an X-ray look at the access), fistulaplasty (balloon angioplasty of any narrowed segments), and declotting as outpatient procedures. These keep the fistula working for as long as possible and let dialysis continue without interruption.

Who needs vascular access?

The most common reasons are: chemotherapy, four-to-six-week courses of IV antibiotics for serious infections (endocarditis, osteomyelitis), TPN (IV nutrition), dialysis, and difficult IV access in patients with otherwise hard-to-find veins. We work in close coordination with your medical team to choose the right access, place it safely, and remove it when you’re done.

References

1. Dariushnia SR, Wallace MJ, Siddiqi NH, et al. Quality improvement guidelines for central venous access. J Vasc Interv Radiol. 2010;21(7):976–981. (Society of Interventional Radiology guidelines.)
2. Gorski LA, Hadaway L, Hagle ME, et al. Infusion Therapy Standards of Practice, 8th Edition. J Infus Nurs. 2021;44(1S):S1–S224.
3. Lok CE, Huber TS, Lee T, et al; National Kidney Foundation. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis. 2020;75(4 Suppl 2):S1–S164.
4. Brass P, Hellmich M, Kolodziej L, Schick G, Smith AF. Ultrasound guidance versus anatomical landmarks for internal jugular vein catheterization. Cochrane Database Syst Rev. 2015;(1):CD006962.

Frequently asked questions

What is a chemotherapy port?

A chemotherapy port (also called a Port-a-Cath, Mediport, or PowerPort) is a small reservoir implanted under the skin of the upper chest, connected by a thin catheter to a large central vein. It allows your oncology team to give chemotherapy, fluids, and medications, and to draw blood, by placing a special needle through the skin into the port — sparing your arm veins from repeated sticks. Modern ports are power-injectable, meaning they can also be used for CT contrast injections, which is convenient when you need imaging during treatment.

What is a PICC line?

A PICC line (peripherally inserted central catheter) is a long, thin tube placed through a vein in the upper arm and advanced to a large central vein near the heart. PICCs are typically used for weeks to a few months — most commonly for outpatient IV antibiotics, but also for chemotherapy, IV nutrition, or when reliable access is needed and a port is not the right choice.

Port versus PICC — which one is right for me?

It depends on how long you’ll need access and how often you’ll use it. A port is fully implanted, can stay in for years, is hidden under the skin between treatments, and lets you swim and shower normally — making it the usual choice for cancer treatment. A PICC has a portion that exits the arm and requires daily care of the dressing, but it’s faster to place and remove — making it the usual choice for several weeks of IV antibiotics. Your oncology, infectious disease, or referring team will guide the choice.

Does port or PICC placement hurt?

Both are outpatient procedures performed under local anesthesia and light conscious sedation. Most patients describe pressure but not pain during the procedure itself, and a sore spot for a few days afterward. There is no surgical incision in the traditional sense — only a small puncture and, for ports, a small pocket beneath the skin. Same-day discharge is the rule.

Can I shower or exercise with a port?

Yes. Once the small incision over the port has fully healed (usually about a week to ten days), you can shower, swim, and exercise normally. Between treatments the port lives quietly under the skin and most people forget it is there. PICCs require more day-to-day care because part of the line is outside the body.

Who places vascular access?

Image-guided vascular access is performed by interventional radiologists. Live ultrasound and X-ray guidance allow precise, safe placement on the first attempt — which is why most national guidelines now recommend image guidance over older landmark-based techniques. Florida Interventional Specialists places vascular access in coordination with medical oncology, hematology, infectious disease, nephrology, and home infusion services.