Loading
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.
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].
Why: The best device differs between an urgent leukaemia course and months of outpatient treatment for a solid tumour.
“Appropriateness of VAD selection varied by type of cancer, treatment urgency, and planned dwell time.”
Why: In a randomised trial ports had about a third fewer complications than PICCs or tunnelled lines.
“For most patients receiving SACT, PORTs are more effective and safer than both Hickman and PICCs.”
Why: These can be placed quickly and give two channels for chemotherapy, blood products and antibiotics at the same time.
“For patients with acute hematologic cancers requiring urgent chemotherapy, placement of a double-lumen peripherally inserted central catheter (PICC) or a tunneled central venous catheter (CVC) was rated as appropriate, regardless of treatment intensity or infusate characteristics.”
Why: PICCs in the arm are more prone to clots, and the right jugular route with a correctly placed tip lowers clot risk.
“Catheters should be inserted on the right side, in the jugular vein, and the distal extremity of the central catheter should be located at the junction of the superior vena cava and the right atrium (grade 1B).”
Why: Lines in the groin carry more infection and clot risk.
“There is insufficient evidence to recommend a specific insertion site, but the femoral vein should be avoided unless there is a contraindication to the other sites (e.g. SVC syndrome), due to the increased risk of infection and concerns about thrombosis [I, A]”
Why: Arm veins used for a PICC may be needed later for dialysis access.
“In patients with advanced chronic kidney disease, coordination of care with a nephrologist to ensure vein preservation in the context of cancer prognosis was recommended.”
How care is usually carried out, read from the guidelines and standards cited. Your own team's protocol and their judgement come first; this page is for understanding it, not for doing it yourself.
For solid tumours needing central access, an implanted port: the CAVA randomised trial found fewer complications than with PICCs or Hickman lines, ITAC (2022) suggests ports over PICCs (guidance), and MAGIC-ONC (2025) rates a port or single-lumen tunnelled line appropriate. For urgent treatment of acute haematological cancers, a double-lumen PICC or tunnelled line (MAGIC-ONC). Right-sided jugular insertion with the tip at the cavoatrial junction (ITAC 1B); avoid the femoral vein (ESMO [I, A]). The sources agree in direction; MAGIC-ONC rates the tunnelled line alongside the port for solid tumours, while CAVA found ports superior to Hickman lines.
The Lancet (Moss et al.) 2021 · Annals of Internal Medicine (Major et al.) 2025 · International Initiative on Thrombosis and Cancer (ITAC), endorsed by the ISTH (Lancet Oncology, Farge et al.) 2022 · ESMO (Annals of Oncology, Sousa et al.) 2015
Where it differs: Places a PICC for most courses because it is quick, done by nurses at the bedside and needs no surgery.
Evidence: CAVA: PICCs had more complications than ports (47% against 32%, OR 0.52 for ports) and similar rates to Hickman lines; ESMO 2015 notes their shorter longevity from higher thrombosis risk; ITAC suggests ports over PICCs. The trial abstract does not report patient preference or waiting times, which can favour PICCs in practice.
The Lancet (Moss et al.) 2021 · ESMO (Annals of Oncology, Sousa et al.) 2015 · International Initiative on Thrombosis and Cancer (ITAC), endorsed by the ISTH (Lancet Oncology, Farge et al.) 2022
| Recommendation | Grade, as printed | Source |
|---|---|---|
| Ports superior to Hickman lines for complications “PORTs were superior to Hickman with a complication rate of 29% (73 of 253) versus 43% (131 of 303; OR 0·54 [95% CI 0·37-0·77]).” | Randomised trial result (OR 0.54, 95% CI 0.37 to 0.77) | The Lancet (Moss et al.) 2021 |
| Ports superior to PICCs for complications “PORTs were superior to PICCs with a complication rate of 32% (47 of 147) versus 47% (93 of 199; OR 0·52 [0·33-0·83]).” | Randomised trial result (OR 0.52, 95% CI 0.33 to 0.83) | The Lancet (Moss et al.) 2021 |
| Ports suggested over PICCs where a central line is needed “In patients requiring central venous catheters, we suggest the use of implanted ports over peripherally inserted central catheter lines (guidance).” | guidance | International Initiative on Thrombosis and Cancer (ITAC), endorsed by the ISTH (Lancet Oncology, Farge et al.) 2022 |
| Solid tumours: single-lumen tunnelled CVC or port appropriate for chemotherapy “For patients with malignant solid tumors, a single-lumen tunneled CVC or implanted port was rated as appropriate for delivering chemotherapy, regardless of treatment intensity, urgency, or duration.” | Rated appropriate (RAND/UCLA) | Annals of Internal Medicine (Major et al.) 2025 |
Shares Catheter-related thrombosis in people with cancer: diagnosis, anticoagulation and whether the line can stay, Peripherally inserted central catheters (PICC lines), Implanted ports for chemotherapy (port-a-cath, power-injectable, apheresis and intraperitoneal ports), Central venous access (port, PICC line).
Shares Implanted port access, flushing and care in adults having cancer treatment, Peripherally inserted central catheters (PICC lines), Implanted ports for chemotherapy (port-a-cath, power-injectable, apheresis and intraperitoneal ports), Central venous access (port, PICC line).
Shares PICC and tunnelled central line care: dressing, hub cleaning, flushing and living with the line, Peripherally inserted central catheters (PICC lines), Infusion pumps, ports, and ambulatory chemotherapy devices, Central venous access (port, PICC line).
Shares Catheter-related thrombosis in people with cancer: diagnosis, anticoagulation and whether the line can stay, PICC and tunnelled central line care: dressing, hub cleaning, flushing and living with the line, Implanted port access, flushing and care in adults having cancer treatment, Peripherally inserted central catheters (PICC lines).
Shares Catheter-related thrombosis in people with cancer: diagnosis, anticoagulation and whether the line can stay, PICC and tunnelled central line care: dressing, hub cleaning, flushing and living with the line, Implanted port access, flushing and care in adults having cancer treatment, Peripherally inserted central catheters (PICC lines).
Shares Peripherally inserted central catheters (PICC lines), Implanted ports for chemotherapy (port-a-cath, power-injectable, apheresis and intraperitoneal ports), Infusion pumps, ports, and ambulatory chemotherapy devices, Central venous access (port, PICC line).
Shares Peripherally inserted central catheters (PICC lines), Infusion pumps, ports, and ambulatory chemotherapy devices, Central venous access (port, PICC line).
Shares PICC and tunnelled central line care: dressing, hub cleaning, flushing and living with the line, Implanted port access, flushing and care in adults having cancer treatment, Peripherally inserted central catheters (PICC lines), Implanted ports for chemotherapy (port-a-cath, power-injectable, apheresis and intraperitoneal ports).