The following article explains the difference between PICC vs Port for Chemotherapy.
Chemotherapy is administered through a central venous catheter or CVC. These long, hollow, plastic tubes are inserted into the patient’s chest or upper arm and transport chemotherapy drugs directly into the bloodstream.
Chemotherapy patients may be able to choose between two types of CVC: PICC vs. port. This article will explore CVCs in more detail, including associated risks, before outlining the key differences and similarities between PICCs and ports.
Why Are CVCs Necessary?
An oncologist may recommend a CVC for one of several reasons:
- The patient is undergoing continuous infusion chemotherapy.
- Treatment will take 24 hours or more to complete.
- The patient will receive treatment in their home.
Unlike regular intravenous (IV) catheters, CVCs can stay in the body for weeks, months, and even years. For patients progressing through a lengthy treatment program, this benefit is essential. If a regular IV catheter were used, it would have to be removed and reinserted every few days, damaging small veins in the process.
Another critical reason a CVC may be necessary is the risks associated with some chemotherapy drugs. Many medications used for chemotherapy are toxic and considered harmful if they leak outside the patient’s veins and into the surrounding tissue. This process is called extravasation.
Chemotherapy extravasation can result in significant damage to patients. Unfortunately, it is not uncommon, with up to 6 percent of patients experiencing the complication when drugs are administered through peripheral intravenous access.
Two types of chemotherapy drugs can result in extravasations of varying severity: vesicants and irritants.
- Vesicants are drugs that can trigger tissue necrosis or the premature death of tissue cells. They can also cause blisters to form in and around nearby tissue. Vesicants include actinomycin D, doxorubicin, idarubicin, vinblastine, and vinorelbine.
- Irritants are drugs that can result in inflammation, irritation, or pain at the insertion site. They do not cause blisters. Instead, patients often experience a burning sensation in their veins as the drug enters the bloodstream. Irritants include bleomycin, dexrazoxane, etoposide, and topotecan.
Types of Central Venous Catheters
Different types of CVCs serve different purposes. Which kind of CVC a patient needs will depend on the following, as well as their oncologist’s preferences:
- The expected duration of chemotherapy
- The dose of chemotherapy required and how long it takes to inject that dose
- How many different drugs the patient will receive at one time
- Whether the patient experiences other medical problems, such as blood clotting
The most common types of CVCs are peripherally inserted central catheters or PICC lines and ports.
What Is a PICC Line?
A PICC line is a catheter tube that an oncologist or nurse inserts into a large vein in the patient’s arm. This insertion process does not require surgery. When inserted, the tube sticks out of the arm’s skin – excess tubing is known as a tail or lumen. Some patients have more than one tail.
Because these tubes are positioned on the outside of the body, patients are at risk of infection. Patients are responsible for mitigating this risk by taking special steps to protect and clean the skin around the tubes. The catheters must also be flushed daily or according to the doctor’s instructions with a sterile solution. This helps to prevent blockages.
Despite best efforts, a study found that the overall complication rate for PICC lines was 30.2 percent, with a mean time to the onset of complications of 16.1 days. Complications included the following:
- Occlusion (blockage) – 8.9 percent
- Accidental withdrawal – 8.9 percent
- Infection – 6.3 percent (4.7 percent local infections and 1.6 percent bloodstream infections)
- Venous thrombosis (blood clot in the veins) – 1.6 percent
- Hematoma (blood clot in an organ, tissue, or body space) – 1 percent
What Is a Port?
A port is a small, drum-shaped object made of plastic or metal. The top of the drum is sealed, and a thin tube – called the line – travels from the drum into the patient’s vein. Ports are inserted surgically underneath the skin in the chest or upper arm. When the port is inserted, most patients notice a small bump in the area. They do not have catheters sticking outside the body.
Chemotherapy drugs are transported into the port via an injection that breaks through its seal. The drugs then move through the line and into the patient’s bloodstream.
PICC vs Port: Key Differences
Both PICCs and ports are used to administer drugs, including chemotherapy drugs. The table below outlines the distinguishing features of the two.
| Feature | PICC | Port |
| Duration | PICCs can stay in the body for several weeks or months. | Ports can stay in the body for as long as the patient requires treatment, up to several years. |
| Maintenance | PICCs require daily maintenance, including cleaning and flushing, to prevent complications like blockages and infections. | Ports do not need daily maintenance. Instead, they require flushing about once per month to prevent clots. |
| Special Considerations | PICCs cannot get wet. Patients must cover tails with waterproof materials when showering and bathing. Patients cannot swim at the pool or beach when a PICC is inserted. | Ports allow for bathing and swimming once the insertion area has healed. |
Holistic Cancer Treatments
Chemotherapy and other conventional treatments come with long lists of side effects and risks. Cancer patients are, therefore, increasingly seeking out holistic, complementary, and alternative medicine to replace or aid traditional therapies.
If you are starting your chemotherapy journey and wish to preserve your quality of life, or if you are interested in learning more about alternative, science-backed therapies, please reach out to our patient care coordinator.
Resources:
Buckner, C A et al. “Complementary and alternative medicine use in patients before and after a cancer diagnosis.” Current oncology (Toronto, Ont.) vol. 25,4 (2018): e275-e281. doi:10.3747/co.25.3884
Grau, Delphine et al. “Complications with peripherally inserted central catheters (PICCs) used in hospitalized patients and outpatients: a prospective cohort study.” Antimicrobial resistance and infection control vol. 6 18. 28 Jan. 2017, doi:10.1186/s13756-016-0161-0
Kreidieh, Firas Y et al. “Overview, prevention and management of chemotherapy extravasation.” World journal of clinical oncology vol. 7,1 (2016): 87-97. doi:10.5306/wjco.v7.i1.87
Velissaris, Dimitrios et al. “Peripheral Inserted Central Catheter Use and Related Infections in Clinical Practice: A Literature Update.” Journal of clinical medicine research vol. 11,4 (2019): 237-246. doi:10.14740/jocmr3757
