This document discusses different types of central venous access for breast cancer patients, including implanted ports, PICCs, and tunneled catheters. It describes factors for choosing an access route and details about PICCs, including placement and average patency rates. Complications of central access are outlined, including early procedural issues and late infections, occlusion, thrombosis, and fibrin sheathing. Prevention and treatment strategies for various complications are provided.

1. Central venous access in Breast
cancer

2. • Central venous access can be divided in to 2
types of access:
-Implanted central venous catheters, including
chest ports and arm ports
-Non-implanted central venous access, including
PICC lines,subclavian catheters, & tunneled
catheters without implanted subcutaneous
ports

3. • Choice of access route depends on multiple
factors:
-reason for central venous catheter insertion,
-anticipeted duration of access,
-intact venous sites available,
-skills of the operator.

7. PICC lines
• Single or dual lumens
• Usually inserted in upper limbs
• With or without USG guidance, with or
without sedation
• PICC lines offer temporary access until an
indwelling catheter can be placed.
• In the absence of any coplication, the average
catheter patency rate is 30.58 days

8. Complications
• Early complications include procedural
complications directly related to catheter
placement such as
-arterial puncture or injury
-pneumothorax,
-air embolism,
-arrhythmia,
-catheter malpositioning,
-venous rupture,
-catheter transection

9. • Late complications
-catheter related infections,
-catheter occlusion,
-venous thrombosis,
-fibrin sheathing,
-catheter fracture and migration.

10. • Catheter related infections presents in 1 of 3
ways:
1)Tunnel or pocket infection
2)Exit site infection
3)Catheter related sepsis
The most common organisms are S.epidermis,
S.aureus, Candida albicans

11. • Prevention of port infection
-meticulous attention to sterile technique,
-gentle tissue handling and proper
hemostasis,precise wound closer
-use of prophylactic antibiotics,
-proper port access training to the nursing staff

12. • Thrombosis
- Either thrombus in the lumen of catheter or in
the native vein.
- Manifested clinically by failure of the port to
tolerate infusion without resistance or the failure
of adequate volume return during aspiration.
- Best evaluated radiographically-if kinking or
twisting of the catheter is absent then thrombosis
is assumed.

13. • Prevention:-sterile technique, flushing the
catheter with heparin saline.
• Treatment of the intraluminal catheter
thrombosis;
-thrombolytic agents

14. • Fibrin sheathing
- Fibrin deposition is inevitable. it occurs regardless
of the insertion technique, catheter material used
and port maintenance regime.
- Clinically fluid can be freely infused but aspiration
is halted.
- A guide wire can be advanced through the
catheter & used to creat the hole in the fibrin
sheath
- Better option-to remove the entire fibrin sheath
using loop snare

15. • Catheter fracture and migration:
(either intra or extra vascular portion)
• Causes
-excessively vigorous exercise or hyper extension
of the neck & body,
-overzealous flushing & testing of the catheter ,
-pinch-off
• Results in extravasation and embolisation