Portacath, Hickman and Picc Lines

What on earth are Portacaths, Hickman or Picc Lines and why might you want/need one?

  • Basically, chemotherapy is administered directly into your veins.  At the end of the day, the chemotherapy drugs are designed to kill the cancer cells but that means that chemo is a bit of a bruiser!  It can negatively affect the veins as it goes through (although this is reversible but does take time and can be painful if you suffer with a collapsed vein).
  • So, what are the options?  Well, you can have a temporary (for the length of your treatment) line put in.  Depending on your consultant/hospital, you will probably be offered a Hickman, Picc or Portacath.  I've got a Portacath so can tell you all about that one but I know a little less about the other two but I hope the information below gives you some idea of what to expect.
Differences between Hickman, Picc and Portacaths

The main difference between the 3 is that a Portacath is totally under the skin - whereas Hickman and Picc lines have their access above the skin.  Of course there are fors and against for each but the main advantage of having a Portacath is that you can hide it, go swimming and as it's under the skin there's less chance of infection.  Of course, the downside is that you do have a scar (about 1-2" long) where they insert it.  

I'm going to be honest that I had to be gently bullied by my chemo nurses to have mine put in!  They introduced me to several patients who had one (who very kindly showed me theirs) and I remember after the lovely gentleman walked out, my husband said to me "well that's probably freaked you out even more!" and he wasn't wrong!  At the end of the day though I had to bite the bullet.  I needed to have it done for safety reasons.  I still don't like it and can't wait to have it taken out BUT it's saving my veins!

So let's see some photos!  If you're squeamish PLEASE DO NOT GO ANY FURTHER!

Portacath (sometimes referred to as a Power Port)

This is my experience of having a Portacath fitted - it may be different for others but hopefully this gives a general idea!  For 3 days before having the Portacath put in, I had to wash with a skin wash (to get rid of bugs - eeeeek!).  It didn't smell too bad and I had to wash my hair with it also. 

I met with the doctor who was going to put it in (he's a specialist radiographer I think) and we discussed where it was going to go.  I told him that there was no way I wanted it above my breast so that it could be seen and as it happened, I didn't have enough fat there anywhere (don't you just love it when you're told you don't have enough fat - chuckles)!  So we settled on an area that was on my actual breast but to the side and more towards my under arm.  You can't have it on your side because your arm would hit it all the time.  So X marked the spot!

I then walked down to the theatre (not quite an operating theatre but a sort of side theatre) and lay on a bed with a huge xray type machine above me. 

I was given local injections to numb the area and I won't lie - they were horrible and hurt!  There were lots of nurses in the room (about 4 and the doctor).  They were all doing different things but I'm not sure what! 

When I was suitably numb, the doctor inserted the portacath under my skin.  I could feel lots of tugging and pulling but it didn't hurt.  I also couldn't see what was happening as I had a green sheet thing over the area and I was laying flat.  If I'd wanted to look I think I could have done but - no thanks!

After the port had been inserted, I was given more numbing injections (or maybe it was a gel I can't remember), at the base of my neck. A small cut (around 1/4 of an inch) was made and a pipe was put inside a vein and fed down to the port where it was attached. All I felt was a rather unpleasant popping session as the pipe went into the vein. The rest was just pulling and tugging again.

At certain points, the doctor stopped, I was xrayed and back he went to work again. 

I think also that he may have injected the port to check that the lines were clear before sewing me up (but I'm not altogether sure about that).  If I remember rightly, the stitches are all dissolvable so I didn't have to worry about having them taken out at a later date.

I can't remember when I first had chemotherapy through the port.  I don't think it was the same day and I think it was about a week later but I might be wrong about that!

One thing that did happen to me though is that because of where my port is, it did twist slightly and the pipe became kinked.  My nurses were really struggling to get blood out or anything in so I had to pop back to theatre for about 30 minutes where the doctor pushed and prodded me and got it to work!  There was no cutting involved that time, phew!

If you look at the picture at the top of the page, you'll see the port close up and the 3 nodes that guide the nurses where to insert the catheter that's attached to it during treatment (to take blood out and chemo in).  There are different types of ports, some have these nodes, others don't and as I've said, the position of where it's inserted is very much an individual one but typically it's somewhere on the chest area.

You can also see the "needle" in the top picture that goes into the port.  It's not really a needle, it's a sort of fine tube attached to a flat back and this is pushed into the squishy bit in the middle of the nodes.  It's not really painful as it goes in (not like having a needle in your arm) it's more of a pressure and a bit uncomfortable.

As I said above, I had to be bullied, kicking and screaming into having mine done.  I don't like it but it's a necessary evil.  I would however suggest you have a line put it if you can,

Hickman and Picc Lines

The main difference between these two lines and the Portacath is that you have the catheter permanently on top of the skin (although it does have a cap on it when not in use to prevent infection). 

I believe the difference between Hickman (seen in the photo to the left) and Picc lines (seen on the right) is that the Hickman can be on the chest area but the Picc line is generally put in the arm area or the crook of the elbow.  I could be wrong about this but I hope this gives you enough information to understand these.

One other thing, with Hickman and Picc lines, they do require flushing with saline and also Heparin to avoid blood clotting (this is the same with the Portacath) but when this is done will be up to your chemo nurses.