# Central venous catheter insertion for anticancer treatment: PICC, tunnelled line and implanted port

Source: https://onco.cc/protocols/central-venous-catheter-insertion-for-anticancer-therapy/  
OnCo record `central-venous-catheter-insertion-for-anticancer-therapy` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A PICC, a tunnelled line or a port is put in by a trained doctor, nurse or radiologist under local anaesthetic, using an ultrasound scan to find the vein, full sterile precautions and a check that the tip sits just above the heart before it is used. Afterwards your breathing and blood pressure are checked, and you should say if you feel short of breath or have chest pain.

## Summary

The insertion bundle is the same for all three devices and comes from infection-prevention and oncology guidelines. A checklist (SHEA 2022, moderate), hand hygiene, alcoholic chlorhexidine skin preparation (ESMO [I, A]; SHEA high quality) and maximal sterile barrier precautions with cap, mask, sterile gown and gloves and a full body drape (CDC Category IB; SHEA moderate); ultrasound-guided venepuncture (SHEA high; CDC IB, by trained operators); the fewest lumens needed (CDC IB); no systemic antibiotic prophylaxis (ESMO [I, A]; CDC IB). Avoid the femoral vein (ESMO [I, A]); ITAC 2022 asks for right-sided jugular insertion with the tip at the junction of the superior vena cava and right atrium to reduce catheter-related thrombosis (grade 1B).

ESMO asks for implanted ports to be placed under strict sterile conditions in an operating room [II, B], and for the tip position to be confirmed by intraoperative fluoroscopy or post-operative chest X-ray [II, B], with intracavitary ECG as an alternative [V, D]. Newer practice moves tip location into the procedure: NICE HTG368 supports an ECG-based tip confirmation system for PICCs in adults, avoiding a chest X-ray unless there is no P wave, and the Italian GAVeCeLT SIC-Port bundle (2026) adds ultrasound vein assessment, a preference for the axillary vein, ultrasound exclusion of pneumothorax, ultrasound tip navigation, intracavitary ECG or echo tip location, and pocket closure with intradermal sutures and glue. After insertion ESMO asks for four-hourly observations and a chest X-ray for breathlessness or chest wall pain [II, C].

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: PICC insertion; port insertion; portacath insertion; Hickman line insertion; tunnelled CVC insertion; central line insertion bundle; CVAD insertion; chest port implantation; SIC-Port

## Connected records

- protocols: [Catheter-related thrombosis in people with cancer: diagnosis, anticoagulation and whether the line can stay](https://onco.cc/protocols/catheter-related-thrombosis-in-cancer/), [Central line and port removal: when, how and what to watch for afterwards](https://onco.cc/protocols/central-line-removal/), [Central line insertion bundle: preventing bloodstream infection at the time of placement](https://onco.cc/protocols/central-line-insertion-bundle/), [Choosing a venous access device for anticancer treatment: port, PICC, tunnelled line or cannula](https://onco.cc/protocols/venous-access-device-selection-for-anticancer-therapy/), [Implanted port access, flushing and care in adults having cancer treatment](https://onco.cc/protocols/implanted-port-access-and-care/), [Midline catheters in cancer care: when to use one, insertion, care and limits](https://onco.cc/protocols/midline-catheters-for-anticancer-therapy/), [PICC and tunnelled central line care: dressing, hub cleaning, flushing and living with the line](https://onco.cc/protocols/picc-and-tunnelled-line-care/)
- technologies: [Implanted ports for chemotherapy (port-a-cath, power-injectable, apheresis and intraperitoneal ports)](https://onco.cc/technologies/implanted-ports/), [Infusion pumps, ports, and ambulatory chemotherapy devices](https://onco.cc/technologies/infusion-devices-vascular-access/), [Peripherally inserted central catheters (PICC lines)](https://onco.cc/technologies/picc-lines/), [PICC tip location systems (Sherlock 3CG, SmartPICC)](https://onco.cc/technologies/picc-tip-location-systems/)
- terms: [Central venous access (port, PICC line)](https://onco.cc/terms/central-venous-access/)

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