Apart from a midline catheter or PICC line, which may be inserted at the bedside, vascular access devices are inserted in an interventional radiology suite (a special room for procedures) or occasionally the operating room. If imaging guidance is not used during placement, a chest x-ray is taken afterwards to confirm that the device is correctly located. At the outset, a sedative medication will be given through a conventional IV line to help you relax. You will feel sleepy but will remain awake for most or all of the procedure. After an area of the upper chest, neck or arm is swabbed with a disinfectant and covered with sterile drapes, a local anaesthetic is injected to numb the venous puncture site. Using ultrasound or fluoroscopy to identify the vein, the radiologist passes a small needle into the subclavian vein, neck vein or arm vein. Through this a small, thin wire called a guide wire is passed into the superior vena cava. The catheter itself is placed over the guide wire, which is then removed.
For a tunnelled catheter, the physician will make two incisions usually smaller than one inch long: one over the vein where the catheter is inserted and the other where the catheter emerges from the skin. The catheter is placed beneath the skin between the two incisions. Finally, the radiologist will place two small stitches, one at each end of the tunnel, which remain in place for about one to two weeks and help keep the catheter firmly in place. A small bandage is placed over the sites and the catheter soon is ready for use. Implanting a port also requires two incisions (except in the arm where a single incision may suffice). The port reservoir is placed under the skin close to the lower incision. The incision for the port is a little longer than for the catheter, usually about two inches long. A small, elevated area remains on the body at the site of the reservoir; you will be able to feel it. The incisions are held together by stitches, surgical glue or a special tape.