PIVs and PICCs and Ports, Oh My!: Understanding Different IV Delivery Methods

Medications are delivered using various devices. Medications must sometimes be administered through an intravenous (IV) route. There are both peripheral and central IV routes. Differentiating between these IV routes and devices might seem confusing. However, there are mainly three common categories: peripheral IVs, peripherally inserted central catheters, and ports.

PIVs

Peripheral IVs (PIVs) are the most common and recognizable type of IV device. When a person is admitted to the emergency room or hospital, a healthcare provider inserts a PIV for the patient. In the event of an emergency, IV medications can be delivered through the PIV even if the person becomes unconscious or is otherwise unable to take oral pills. IV medications take effect within a few minutes, compared to one hour with oral medications. Every second counts in emergent medical situations, and IV medication delivery can mean the difference between life and death. 

PIVs are typically inserted into the hand, forearm, or antecubital fossa (the front of the elbow, where the arm bends). The IV insertion device contains a thin needle covered by a flexible plastic tube, called a catheter. The needle is used to guide the catheter into the vein. Once the device is secured in the vein, the needle is retracted. The flexible catheter remains in place. The catheter is then connected to IV tubing. IV fluids and medications can then be delivered through the IV tubing.

There are some benefits and some risks associated with PIVs:

Benefits

• Short-term placement

  • Easily removed after a few hours or a few days.

• Easy access for emergent use

Risks

• Infection

• Bruising

• Blood clot

• Phlebitis (inflammation of the vein)

Although PIVs can last for several days, hospitals and clinics typically require them to be replaced every 72 hours. This scheduled replacement reduces the risk of infection and/or damage to the vein and surrounding tissue. This protocol is important, especially for immunocompromised patients. PIVs are typically removed upon discharge from the hospital/clinic.

PICCs

A peripherally inserted central catheter (PICC) is used for long-term outpatient treatments or long-term hospital stays. PICCs can stay in place for several weeks or months. People who are immunocompromised have their PICC removed or replaced after 6 weeks to reduce the risk of infection.

A PICC is placed during a procedure in the radiology department. The technician uses a continuous X-ray image (fluoroscopy) to view the location of the catheter during the insertion. Local anesthesia is administered to the insertion site, but the patient remains awake during the procedure. The PICC is inserted into a peripheral vein, such as the basilic (most common), cephalic, or brachial. The catheter is then threaded through the vein until it reaches the superior vena cava. The superior vena cava is located next to the right atrium of the heart. This location provides a direct delivery route for medications into the bloodstream. The remaining exterior portion of the PICC includes a single or double tubular access. These exterior tubular access devices are referred to as “lumens.” IV medication is administered through the lumen.

A PICC provides many conveniences, but of course includes some risks:

Benefits

• Fewer needle sticks

• Reduces risk of peripheral vein or tissue damage

Risks

• Bleeding at the insertion site

• Blood clot formation

  • If this is suspected, an ultrasound might be performed to identify the location of the blood clot.

  • If a blood clot is identified, medication might be ordered. The PICC might also be removed.

• Nerve damage

• Irregular heartbeat (due to the placement of the catheter near the superior vena cava and right atrium of the heart).

PICC lines require weekly maintenance. When not in regular use, they are flushed with normal saline to reduce the risk of blood clots forming. This also ensures that the PICC is functioning properly. PICC lines also require weekly dressing changes. This is a sterile procedure that includes cleaning the skin at the insertion site, replacing the antiseptic foam disc, and placing a new transparent dressing. Once the course of treatment is complete, a PICC line can be removed at the bedside, in an outpatient clinic, or at home by a home health nurse.

Ports

An implantable port is placed when long-term treatment is needed. Examples of long-term treatments include chemotherapy, IV antibiotics, and complex conditions that require frequent IV infusions and blood draws. Ports can remain in place for years.

The port is placed during a procedure that occurs in the radiology department. Patients are typically awake for the procedure. Local anesthesia is administered to the insertion site, located in the upper chest (most common) or arm. A small incision is made to access the vein for the port catheter. Another small incision is made below the skin where the implantable port device is placed. The catheter is threaded from the port up the vein until it reaches the superior vena cava. The skin at the insertion site is closed with stitches.

The location of the port is often visible. It can also be located by palpating the skin. Ports have one or two access points. The port is accessed through a sterile technique where a port needle is inserted into the septum (center of the port). A dressing is placed, and the port needle is connected to IV tubing.

There are many benefits and some risks associated with ports:

Benefits

• Reduced number of needle sticks

• People can swim with a port

• Low risk of infection (2%)

Risks

• Thrombosis

• Mechanical issues

  • If a port is not flushing properly, the person may need to come into a clinic or the emergency room for intervention

  • If initial interventions fail, the port might need to be replaced

• Scarring

When a port is accessed, the needle and dressing need to be changed every 7 days. This reduces the risk of infection. This is a sterile technique that can be performed in the hospital, outpatient clinic, or at home by a home health nurse. A port can be removed soon after completing treatment, depending on your doctor’s recommendations.

The Benefit of Options

PIVs are typically placed as soon as a person is admitted to the ER or hospital. A doctor might recommend a PICC or port placement for long-term treatment. PIVs can last for 3 days, PICCs can stay in place for several weeks or months, and implantable ports can last for years. Each device requires different maintenance. Although there are some risks associated with each device, they each provide convenience when it comes to receiving treatment. Always follow the care and safety instructions from your healthcare provider regarding your IV, PICC, or port.

References

Agarwal, A., Montanarella, M. J., & Moon, B. (2024, January 10). Peripherally inserted central catheter (PICC) line placement. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK573064/

American College of Surgeons. (2017). Implanted port: Accessing and removing the noncoring needle [PDF]. Division of Education. https://www.facs.org/media/ukjjs5uz/implanted_port_accessing_and_removing_the_noncoring_needle.pdf

Cleveland Clinic. (2023, April 27). Peripheral IV. Retrieved October 19, 2025, from https://my.clevelandclinic.org/health/treatments/24930-peripheral-iv

Mayo Clinic Staff. (2025, August 8). Peripherally inserted central catheter (PICC) line. Mayo Clinic. https://www.mayoclinic.org/tests-procedures/picc-line/about/pac-20468748

MedlinePlus. (n.d.). Peripherally inserted central catheter – dressing change. U.S. National Library of Medicine. Retrieved October 19, 2025, from https://medlineplus.gov/ency/patientinstructions/000462.htm

Olivier, R. C., Wickman, M., Skinner, C., & Ablir, L. (2021). The impact of replacing peripheral intravenous catheters when clinically indicated on infection rate, nurse satisfaction, and costs in CCU, Step-Down, and Oncology units. American Journal of Infection Control, 49(3), 327–332. https://doi.org/10.1016/j.ajic.2020.07.036

What is a chemo port? (2023, January 31). Cleveland Clinic. Retrieved October 19, 2025, from https://my.clevelandclinic.org/health/treatments/24663-chemo-port

Assessed and Endorsed by the MedReport Medical Review Board