What are the different catheters and ports? When are each used?

What are the different catheters and ports? When are each used? There's a lot of different catheters out there and basically when we need to put in catheters there's different options. And so the easiest is a peripheral IV and that's perfect for a drug that you're giving over a few hours that won't damage the veins. The veins are easy to find and the nurse doesn't have a problem. That's the most straightforward low risk. Unfortunately with myeloma patients, especially after many years of treatment, especially if they're getting a lot of frequent IVs, the veins can get damaged. And so then you need to move to other types of access. And unfortunately, of course, we love some drugs to be oral, but not all drugs can be given orally. So then what are our other options? So a PICC line is basically, it stands for peripherally inserted central catheter and it's inserted in the arm vein. So it's not a neck or chest wall, it's in the arm, but it has a very long internal tubing. So even though it may look like it's an IV, it's slightly thicker, it really starts here because all the way in can start from either arm and ends up going into the top of the heart known as the atria. And so that it should sit right above that and you can deliver this chemotherapy through there. That allows continuous IV chemo to be given. It can be left in for several weeks. You can draw blood from it. You can get several lumens from that. So it's a very useful device. And then when you're done with whatever you're doing, you can pull it out with the appropriate individual, not by your typical just bedside nurse. Then we can have different types of catheters that are inserted in the neck. Even things like Shilies or Hickmans, they differ. So both Shilies and Hickmans are removable catheters. They're not intended for forever use. They typically do have multiple lumens. Shilies are often larger bore. They stick out, they go up vertically. Shilies are typically used for things like leukophoresis for stem cell collection. And the reason for that is the machines that are pulling off blood, we need to pull at a fast rate. And if you have a very floppy IV, you're going to be there all day and not get the cells that you need collected. So sometimes Shilies are put in for stem cell harvesting. They can also be used for dialysis. So because anytime you're pulling blood off at a fast rate, you need a large bore catheter that will withstand the pressure of that procedure. Hickmans are typically also central lines. They're also put in the neck, but they tend to be thinner. Often these are used preferentially in patients who are being admitted and for myeloma patients admitted for transplants because you need central lines for those patients for a couple of reasons. One is obviously the chemotherapy is easier to give. The stem cells we know are getting to where they need to go when we're putting them in. It's kind of amazing that you give stem cells peripherally and then they just know where to go, right? And they go into the bone marrow, but you need to make sure they're at least getting in properly. Also because the typical auto transplant patient may need IV access for antibiotics, blood fusions for two to three weeks. This Hickman can be left in there and it can be the patient's best friend, right? So instead of having been poked and prodded all the time, you can do that. And it's also useful if you're needing multiple blood draws, perhaps in somebody who's very sick. The final device is a port. So port is also a central line, but this basically has an access site that's about a quarter size device. They come in single or double lumen, meaning one or two entry points for needles. And then they're tunneled under the skin and then also that catheter goes into the top of the heart. What this port allows us to do is this device can be left in for many years. It just needs to be flushed once a month and importantly, it needs to be accessed by people who are trained in port use. So typically chemotherapy nurses who will clean off the skin, they're often wearing a mask to avoid, because the biggest thing is when you're accessing the port. But you can shower with this and unlike other catheters that you need to protect, this is pretty easy to use. And so it's very convenient for somebody that we know is going to be on an IV chemotherapy regimen for a long time and will avoid repetitive trauma to the veins.