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Central venous access devices are usually inserted in 1 of 3 ways.

• Catheters are inserted by tunneling under the skin into either the subclavian vein (located beneath the collarbone) or into the internal jugular vein (located in the neck). The part of the catheter where medications are administered or blood is drawn remains outside the skin.



• Unlike catheters, which exit from the skin, ports are placed completely below the skin. With a port, a raised disk about the size of a quarter or half dollar is felt underneath the skin. Blood is drawn or medication is delivered by placing a tiny needle through the overlying skin into the port or reservoir.



• Peripherally inserted central catheter (PICC) lines, unlike central catheters and ports, are not inserted directly into the central vein. A PICC line is inserted into a large vein in the arm and advanced forward into the larger subclavian vein.

A surgeon or surgical assistant in a surgical suite usually inserts central catheters and ports. An alternative is placement under the guidance of a special x-ray machine so that the person inserting the line can make sure that the line is placed properly. A PICC line can be put in at bedside, usually by a specially trained nurse.

Peripherally inserted central venous access devices have increasingly replaced traditional surgically placed central catheters. PICC lines usually cause fewer severe complications than central venous access devices.

IV access, whether by temporary traditional IV line, central catheter, port, or peripheral line such as a PICC, is becoming an important part of health care today.

• Uses for long-term venous access and the decision to have a port or catheter have become increasingly more complex.



• Individuals being treated using a venous access device should discuss the different choices with the primary care provider or the specialist providing treatment.

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