Need vascular access for treatment?

Need vascular access for treatment?

Vascular access or long-term intravenous lines are often needed by patients undergoing treatment for a number of weeks, month or even years. Typically these are cancer patients receiving chemotherapy or patients needing a long course of intravenous antibiotics, also patients who are on haemodialysis because of kidney failure.

Throughout his career, Dr Burfitt has worked with cancer specialists, renal and general medicine doctors to provide a high quality venous access service to ensure patients undergoing long-term treatment can maintain their intravenous therapy at all times.

Line insertions are performed under ultrasound and low-dose X-ray imaging. Patient are kept comfortable with local anaesthetic and intravenous sedation, for the more involved lines general anaesthetic is the better option. The procedures are quick, taking around 20 minutes, patients can go home after 1-2 hours recovery.

Types of intravenous lines:

'Ports' - Portacath, Powerport
These lines are completely contained under the skin, with no tubes or valves outside the body. The port has a small chamber which is placed under the skin on the upper chest a few centimetres below the collar bone. A small tube is attached to the chamber, this passes under the skin up over the collar bone into a vein in the neck (internal jugular vein), then down into the chest within this vein. Ports are usually inserted under general anaesthetic or heavy sedation to keep the patient comfortable throughout.

To use the port, a fine need is passed through the skin into the chamber. Medicines can then be injected safely and also blood taken for blood tests.
Once the small incision for the port has healed, you can return to normal life in terms of showering, baths, swimming and sports.

Ports transform the experience of patient undergoing chemotherapy, taking away the stress and discomfort of repeated attempts to get access to a vein for each treatment. In addition, repeated access to the veins of the hands and arms makes the finding a good vein more and more difficult. Ports avoid all of this.

PICC line (Peripherally Inserted Central Catheter), Mid line
This is a very small tube (less than 2mm in diameter) which is inserted into a vein in the upper arm. The tubes passes along the arm into a larger vein in the chest.

PICC lines and Mid lines are an alternative to ports, usually when the intravenous access is needed for just a few weeks.

Vascular Access/Lines

Hickman line, Groschong line
These lines are placed in a similar position to a portacath, the difference is the tube comes out through the skin overlying the chest, this avoids the use of a needle at anytime. They are also preferred for some cancer treatments or if there might be on-going infection elsewhere in the body as they are quicker to inserted and change if necessary.

Vascular Access/Lines

Tesio lines for haemodialysis
This is a central venous catheter which can be used for haemodialysis. The lines may be temporary while the alternative venous access of a dialysis fistula is being set up surgically. Tesio lines also provide good venous access in the long term for dialysis.

Long-term Tesio line patients can sometimes be a challenge for maintaining intravenous access, Dr Burfitt is experienced in specialist catheter exchange techniques to ensure haemodialysis access is maintained for these patients.