Image-guided placement of dedicated central venous access devices for chemotherapy, long-term IV therapy, or dialysis — chosen to match how long, and how, treatment access is needed.
Certain treatments — chemotherapy, long courses of IV antibiotics, parenteral (intravenous) nutrition, and frequent blood sampling — either require access to a large, high-flow central vein, or simply involve too many needle sticks to reasonably continue using standard peripheral IV lines in the arm. Repeated peripheral IVs also become progressively harder to place as veins are used, and certain chemotherapy drugs can cause serious tissue damage if they leak from a small peripheral vein. Dedicated central venous access devices solve this by placing a catheter with its tip in a large central vein near the heart, providing reliable, lower-risk access for as long as treatment requires — whether that's weeks or several years.
Favoured for treatment running months to years, given in intermittent cycles, with a low-maintenance device with nothing external.
Favoured for a defined, medium-term course, where ease of insertion and removal is a priority.
Favoured for continuous or high-volume access over a prolonged period, or dialysis access.
Ultrasound is used beforehand to select a healthy, appropriately sized vein.
Under local anaesthesia, the vein is punctured under real-time ultrasound guidance.
The catheter or port is advanced, with its tip guided to the correct central vein.
A chest X-ray confirms correct tip position before the device is used, typically same-day.
A chemoport is a small reservoir, roughly the size of a coin, connected to a thin catheter and placed entirely beneath the skin, usually on the upper chest. Because the whole device sits under the skin, there's nothing external to see or manage day to day — the port is simply accessed with a special needle through the skin whenever treatment is needed, and otherwise requires very little maintenance between uses. This makes it particularly well suited to chemotherapy given in cycles over months to years, where treatment is intermittent rather than continuous, and where patients want to be able to shower, swim, and go about daily life without an external tube to manage. Comparative studies have generally found ports carry a lower overall complication rate than PICC lines over long-term use, which is part of why ports are often preferred when treatment is expected to continue for an extended period.
A PICC line is inserted through a vein in the upper arm and threaded along until its tip sits in a large central vein close to the heart, with a portion of the catheter remaining outside the skin at the arm. PICC lines are valued for how straightforward they are to place and remove, without the need for even the small procedure a port or tunnelled line requires for removal, and they work well for medium-term needs — typically weeks to a few months — such as a defined course of IV antibiotics, nutritional support, or chemotherapy regimens that don't extend over a very long period. Because part of the catheter is external, it needs regular dressing changes and some day-to-day care to keep the exit site clean and reduce infection risk, and the arm with the PICC needs some activity precautions during the time it's in place.
A tunnelled catheter is placed into a central vein, typically in the neck or chest, but — as the name suggests — is then passed under the skin for a short distance ("tunnelled") before it exits, with a cuff along its length that encourages the surrounding tissue to grip the catheter, adding stability and acting as a barrier against infection tracking in from the skin. Tunnelled catheters are generally used when continuous, higher-volume, or more urgent access is needed for a more prolonged period — for example, certain intensive chemotherapy or nutritional regimens, or specific situations such as ongoing dialysis access — often when a fully implanted port wouldn't suit the pattern or intensity of treatment required.
There's no single device that's right for every situation — the choice depends on how long access is likely to be needed, how the line will be used (occasional cycles versus continuous infusion), the number and type of medications or fluids involved, the condition of the patient's veins, and personal preference around lifestyle and device care. This decision is generally made jointly between the referring physician or oncologist planning the treatment course and the interventional radiology team performing the insertion, taking all of these factors into account rather than defaulting to one option.
Favouring a chemoport: treatment expected to run for many months to years, given in intermittent cycles, with a strong preference for a low-maintenance device with nothing external.
Favouring a PICC line: a defined, medium-term course of treatment, where ease of insertion and removal is a priority, and the patient is comfortable managing a dressing and some activity precautions.
Favouring a tunnelled catheter: continuous or high-volume access needed over a more prolonged period, or a specific clinical need such as dialysis access.
Planning: ultrasound is used beforehand to select a healthy, appropriately sized vein for access.
Access: under local anaesthesia, with light sedation if needed, the vein is punctured under real-time ultrasound guidance.
Placement: the catheter or port is advanced into position, with its tip guided to the correct location in a large central vein, confirmed using X-ray guidance or other tip-confirmation technology during the procedure.
Securing: a chemoport is placed in a small pocket under the skin and closed with a few stitches or adhesive strips; a PICC or tunnelled line is secured at its exit site with a dressing, and a tunnelled line's cuff is positioned just under the skin along its tunnelled course.
Confirmation: a chest X-ray or other imaging check confirms the catheter tip is in the correct position before the device is used.
The whole procedure typically takes 30 to 60 minutes, and patients generally go home the same day, with the device ready to use immediately or very soon afterward.
All three devices are generally safe when placed under image guidance by an experienced team, though as with any indwelling catheter, recognised risks include infection, blood clot formation around the catheter, and, less commonly, issues with the catheter's position or function over time. Good ongoing care — meticulous hygiene when the line is accessed, correct dressing changes for external devices, and regular flushing to keep the catheter patent — meaningfully reduces these risks, and patients and caregivers are given clear instructions on this before discharge. Any fever, redness or swelling at the site, or difficulty using the line should be reported to the treating team promptly.
Correct vein selection, precise catheter tip positioning, and careful technique during insertion all directly affect how well these devices function and how low their complication rate is over their working life. This is why chemoport, PICC, and tunnelled line placement are best performed under real-time ultrasound and imaging guidance by an interventional radiology team with specific experience in vascular access, working closely with the oncology, nephrology, or other referring team planning the patient's treatment.
Neither is universally "better" — it depends on your situation. Ports tend to suit longer, cycle-based treatment with lower day-to-day maintenance and, in comparative studies, a lower overall complication rate, while PICC lines suit more defined, medium-term courses and are simpler to place and remove.
A chemoport is entirely under the skin, so there's a small, barely visible bump but nothing external to manage day to day. PICC lines and tunnelled catheters have a visible external portion that needs a dressing and some care.
It's done under local anaesthesia, with sedation available if needed, so the procedure itself is generally well tolerated. Most patients describe some pressure during placement and mild soreness at the site afterward.
It varies by device and clinical need — PICC lines are typically used for weeks to a few months, while chemoports and tunnelled catheters can remain in place safely for many months to a few years if needed and well cared for.
A PICC line can usually be removed at the bedside with gentle traction. A chemoport or tunnelled catheter needs a short, minor procedure, similar in scale to the original insertion, to remove it safely.
Book a consultation with Dr. Giragani to discuss the right device for your treatment plan.