# Choosing a venous access device for anticancer treatment: port, PICC, tunnelled line or cannula

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

## TL;DR

If you need many months of treatment into a vein, a central line saves repeated needles. For most people with solid tumours, a randomised trial found an implanted port under the skin had fewer problems than a PICC in the arm or a tunnelled line in the chest. For urgent treatment of leukaemia and similar cancers, a PICC or tunnelled line with two channels may suit better.

## Summary

The CAVA trial (UK, 1061 adults, 2021) compared Hickman-type tunnelled catheters, PICCs and implanted ports for at least 12 weeks of anticancer therapy. Ports had fewer complications (a composite of infection, venous thrombosis, pulmonary embolus, inability to aspirate, mechanical failure and others) than Hickman lines (29% against 43%, OR 0.54) and than PICCs (32% against 47%, OR 0.52); PICCs and Hickman lines had similar rates, with non-inferiority not confirmed. The authors concluded that most patients receiving anticancer therapy for solid tumours should receive a port in the NHS.

MAGIC-ONC (2025, RAND/UCLA appropriateness method, 1422 scenarios) rated a single-lumen tunnelled CVC or a port appropriate for chemotherapy for solid tumours regardless of intensity, urgency or duration, and a double-lumen PICC or tunnelled CVC appropriate for urgent chemotherapy in acute haematological cancers; in advanced chronic kidney disease it advises coordinating with a nephrologist to preserve veins. ITAC (2022) suggests ports over PICCs where a central line is needed (guidance) and right-sided jugular insertion with the tip at the cavoatrial junction (1B). ESMO (2015) notes that PICCs' main limitation is shorter longevity from a higher risk of thrombosis and advises avoiding the femoral vein [I, A].

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: port or PICC; PICC versus port; Hickman versus port; choice of central line for chemotherapy; vascular access device selection; CAVA trial; MAGIC-ONC

## 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 venous catheter insertion for anticancer treatment: PICC, tunnelled line and implanted port](https://onco.cc/protocols/central-venous-catheter-insertion-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/), [Peripheral cannula for anticancer treatment: vein choice, siting and checks, including vesicants](https://onco.cc/protocols/peripheral-cannula-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/)
- terms: [Central venous access (port, PICC line)](https://onco.cc/terms/central-venous-access/)

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