Top 5 Considerations When Choosing PICC Access Versus Implantable Ports
PICCs (peripherally inserted central catheters) and implantable ports are both vascular access devices. Their primary purpose is to allow the repeated administration of drugs over a period of time. That period of time could be anything from days to weeks. Which one is better, though – PICC access or implantable ports?
The short answer is that it depends – it depends on the condition being treated, the medication being administered, the duration of the treatment, and the circumstances of the patient, among other things.
- PICC access – a catheter device inserted and navigated along a peripheral vein, usually in the arm, to a large vein in the chest.
- Implantable port – a catheter placed in a large vein in the chest and attached to a port that is implanted, i.e., placed beneath the skin on the chest.
So, how do you choose between PICC access and implantable ports? Here are five essential considerations that will help in your decision-making.
Duration of Access
PICC access is generally the best option when the device will be in place for anything up to about two weeks. This would be regarded as a short-term access requirement.
Medium-term access is typically up to several months in duration. Depending on the application, both PICC access and implantable ports are possible options.
For long-term access where the device will be in place for multiple months or even years, implantable ports are the best option. This is primarily because there is a decreased risk of complications or infection with an implantable port.
Implantable ports are also easier to live with for patients, as they can continue with almost all normal activities without interruption, including swimming and taking showers.
Number of Lumens
PICC access devices can have multiple lumens to, for example, facilitate the simultaneous infusion of drugs that are not compatible with each other.
However, complications (such as deep vein thrombosis) increase based on the diameter of the catheter and the number of lumens, i.e., the bigger the diameter and/or the greater the number of lumens, the higher the risk of complications.
In general, the best approach whether using PICC access or implantable ports is to use the fewest lumens and smallest diameter catheter possible.
That said, and combined with the other considerations on this list, particularly duration of access, implantable ports can often be more appropriate when using multi-lumen catheters.
Catheter Diameter
As mentioned above, thrombosis risks increase when using PICC access devices with larger diameter catheters.
Flow rate is also impacted by catheter diameter, adding to the importance of catheter size when choosing between PICC access and implantable ports. Specifically, implantable ports are typically accessed using small caliber catheters.
Infusion rates are usually lower with small caliber catheters, as the narrowness of the catheter’s internal diameter slows the passage of medication. This can make implantable ports unsuitable for certain applications, including where there needs to be large volumes of fluid infused continuously.
Characteristics of the Intravenous Fluid
The issue of infusion rates mentioned above is an important consideration for many applications, so the infusate should be considered in addition to the diameter of the catheter.
Furthermore, there is also research that patients who are receiving blood transfusions, particularly frequent blood transfusions, are at a higher risk of thrombosis when the transfusion is through PICC access compared to alternative methods.
It’s also important to consider other characteristics of the infusate, including the pH and osmolarity, particularly in relation to the risk of damage to tissue or blood vessels.
Patient Characteristics
Procedures to place implantable ports are more invasive than PICC access placements, so there can be higher levels of pain and discomfort for patients. Depending on the application and the specific circumstances of the patient, this higher level of invasiveness can also mean surgical suites are required for the placement and removal of implantable ports.
Clinical decisions on PICC access or implantable ports can also come down to other patient requirements, such as being uncomfortable with the appearance of an implantable port or to facilitate a patient’s lifestyle.
For example, with PICC access, patients should generally avoid strenuous activities or activities that will potentially get the PICC line wet, such as swimming. Precautions even have to be taken when showering. This can be okay over the short or medium term, but for longer periods of time, an implantable port is usually more suitable.
Conclusion
Both PICC access and implantable ports are safe and well-established methods of gaining repeated vascular access in patients. The right choice for your medical device or clinical application is largely dependent on the considerations highlighted above.
At Galt, we manufacture introducers and other devices that are suitable for both PICCs and implantable ports. For advice specific to your requirements, please get in touch with a member of our team today.
