Patients undergoing chemotherapy treatment of cancer will require sustained intravenous access. Intravenous access is required for administrations of treatment and frequent blood tests. Given the frequency of intravenous access required, many patients will benefit from the placement of an access device. This is especially true for patients who do not have easily accessible veins. Furthermore, some chemotherapy agents may cause burning or discomfort when administered through veins in the arm. In an effort to facilitate the delivery of chemotherapy under these conditions, physicians began using vascular access devices approximately 20 years ago.

Vascular Access Devices Utilized for Cancer Treatment

Although there are several different types of vascular access devices, tunneled external catheters (Hickman) or subcutaneous implanted ports (port-a-cath) are most often used for sustained intravenous access required for cancer therapy. Either a port or Hickman may be used to facilitate the delivery of chemotherapy and the drawing of frequent blood samples.

A port is surgically implanted completely beneath the skin. The port may then be accessed by a special needle through the skin to deliver chemotherapy, hydration, transfusions and frequent blood samples. A plastic tube inside the body connected to the port delivers intravenous agents directly into a major vein under the collar-bone. A Hickman also requires surgical access of a major vein. However, the plastic tube or catheter is surgically attached to a major vein subcutaneously and then comes out of the body for external access.

Port Versus Hickman

A port is associated with fewer device related infections, fewer activity restrictions and less day-to-day maintenance compared to a Hickman. On the other hand, a Hickman is associated with easier insertion, removal and access.

In addition, a Hickman may have a single, double or triple lumen (channel), but a port may only have a single or double lumen. Consequently, a Hickman is associated with a higher flow capacity than a port. Patients undergoing very demanding therapies that require frequent blood transfusions, nutritional support and treatment delivery may be required to have a Hickman instead of a port.

Who Needs a Vascular Access Device

Every chemotherapy patient does not require a port or a Hickman. For example, the inconvenience of implanting and accessing a vascular access device may outweigh the benefits for some chemotherapy protocols. You may wish to ask your doctor if a port is an option for you, especially if you experience any of the following.

• You are extremely anxious about having needles inserted.
• Your veins are difficult to access.
• You are undergoing continuous infusion chemotherapy (over an hour).
• You anticipate many months of chemotherapy treatments.
• You are receiving intravenous chemotherapy that requires multiple needle sticks.
• Your treatment requires frequent drawing of blood samples.
• Your treatment strategy involves chemotherapy agents that may cause “vein pain” when administered through the arm.
• You have a physician or nurse who recommend a vascular access device.

Patient Suggestions

A majority of patients with a vascular access device highly recommend it as an alternative to multiple needle sticks. Patients warn that if arm veins become inaccessible from repeated use, then accessing alternative veins in the foot or hand may be associated with more discomfort. In addition, some patients warn that arm “vein pain” associated with specific chemotherapy agents may become progressively worse with each additional chemotherapy cycle and may be avoided with an access device.

Patients also suggest having a port implanted by an experienced surgeon. Some patients even suggest asking the treatment room nurses which surgeon they recommend.

In most cases where a vascular access device was optional, patients suggest having an access device to minimize discomfort later. Determining if a port is right for you may depend on your chemotherapy protocol, your concerns and your doctor’s recommendations.

Information presented in The Daily Tip is offered as a guide to augment a patient’s research of cancer and treatment and does not replace the advice of a doctor. For more information on a specific cancer, go to CancerConsultants.com, www.cancer.gov, and consult your physician.