Vascular Access and Goals of Care

When serious illness reaches a point where the focus of care shifts — from curing disease or maximally treating it, toward managing symptoms and maintaining the best possible quality of life — many aspects of medical care are reconsidered. One of these is vascular access: the catheters, ports, and IV lines that have been part of treatment.

This guide is written for patients and families navigating that transition. It addresses the practical and deeply personal questions that arise: What happens to the PICC or port now? Does the IV line still help or is it now a burden? Are there better ways to give medications for comfort? How do I talk to my team about this?

There are no universal right answers. Every person’s situation is different. This guide offers a framework for thinking through these questions — not a script.

What Does “Goals of Care” Mean?

Goals of care is a term used in medicine to describe a conversation — or series of conversations — about what matters most to you, what you hope treatment will accomplish, and how you want to live during illness.

Goals of care are not just end-of-life conversations. They are relevant whenever:

Your illness has progressed despite treatment
A proposed treatment is burdensome and the benefit is uncertain
You are facing a decision about starting or continuing intensive therapy
You want to ensure your team understands what quality of life means to you

When goals of care shift toward comfort or palliative focus, it means the priority of medical decisions moves toward how you feel rather than (or in addition to) what the test results show.

Vascular Access in the Context of Goals of Care

Why this conversation matters

Vascular access devices — PICC lines, implanted ports, tunneled catheters, and other central lines — are tools. Like any medical tool, they are appropriate when their benefit exceeds their burden. When goals of care shift, this balance needs to be reconsidered:

Does the catheter still serve a purpose? If IV medications, IV nutrition, or IV access for blood draws is still needed to manage symptoms and maintain quality of life, the catheter may still be valuable.
Does the catheter now cause more burden than benefit? If IV therapy is no longer providing meaningful benefit, the catheter, its care requirements, its dressing changes, its restrictions on bathing and activity, and its infection risk may outweigh any remaining advantage.

Neither keeping nor removing a catheter is automatically the right choice. The right choice depends on what it is being used for, what your goals are, and how it is affecting your life.

When a Catheter Is Helpful in Palliative Care

Vascular access remains valuable in palliative and comfort-focused care when it serves clear comfort goals:

Medication delivery for symptom management

IV or subcutaneous medications for pain, nausea, breathlessness, anxiety, and agitation can dramatically improve quality of life. A catheter or subcutaneous access point can deliver these medications:

Continuously via a pump or syringe driver (providing steady symptom control without peaks and troughs)
On demand for breakthrough symptoms
Without repeated needle sticks

For some patients, a PICC or port provides reliable access for these medications in a way that peripheral IV or subcutaneous access cannot match.

Managing specific symptoms that require IV access

Some symptoms — refractory nausea requiring IV antiemetics, severe dehydration causing distressing thirst, or specific infusion treatments — may genuinely benefit from IV access even in a comfort-focused care setting.

Reducing the need for repeated needle sticks

For patients on hospice who need frequent blood draws (even if the goal is monitoring for symptom management rather than treatment), existing access spares them repeated venipunctures. However, the value of this must be weighed against the burden of maintaining the device.

When a Catheter May No Longer Be Appropriate

A catheter may no longer be appropriate when:

The treatment it was placed for is no longer being given. If a PICC was placed for IV antibiotics and the course is complete — or the decision has been made to stop antibiotics as they are no longer providing benefit — the PICC serves no purpose.
The care burden exceeds the benefit. Regular dressing changes, flushing, restrictions on bathing and activity, and nursing visits all take time, cause discomfort, and limit freedom. For someone focused on quality of life, these burdens deserve honest accounting.
Infection risk outweighs remaining benefit. All indwelling catheters carry infection risk. In a comfort-focused setting, a catheter infection requiring hospitalization would directly undermine the goal of remaining comfortable at home or in a familiar setting.
Alternative routes are adequate. Oral medications, subcutaneous infusion, suppositories, and sublingual routes can deliver most comfort medications effectively without IV access. If these routes are adequate for managing your symptoms, maintaining a catheter solely for IV access may not be justified.
You or your family do not want it. Your preferences about your own body and what is connected to it matter. If maintaining a catheter feels burdensome, intrusive, or simply no longer aligned with how you want to live, that is a valid reason to consider removal.

IV Fluids at End of Life: A Common Question

Whether to continue — or start — IV fluids as a person nears the end of life is one of the most common and emotionally complex questions in palliative care. There is no single right answer, and the evidence is nuanced.

When IV fluids can help

Temporary dehydration with a reversible cause (e.g., severe vomiting that can be controlled, inability to drink due to a treatable condition)
Symptoms of dehydration that are causing distress — dry mouth, thirst, confusion that is clearly related to dehydration

When IV fluids may not help — and may cause harm

As a person approaches the natural end of life, the body progressively reduces its need for fluid:

Fluid may accumulate in tissues (edema) and lungs (pulmonary edema), causing breathlessness and discomfort rather than comfort
The dying process naturally involves reduced fluid intake — forcing hydration can prolong the dying process without improving comfort or consciousness
Dry mouth — one of the most commonly cited concerns — is not reliably relieved by IV fluids. It is more effectively managed with good mouth care (ice chips, swabs, saliva substitutes)
Hunger and thirst decrease naturally at end of life and are typically not experienced as distressing by those who are dying when good comfort care is provided

Research does not consistently show that IV fluids at end of life improve comfort, reduce suffering, or prolong life in a meaningful way. In some cases they worsen comfort.

This is not about withholding care. It is about recognizing that in the final stage of life, the body’s needs are different, and gentle mouth care may serve better than an IV drip.

Talk to your palliative care team about this. They can help you think through whether IV fluids are likely to help in your specific situation, and they understand the difference between dehydration that causes distress and the natural process of the body winding down.

IV Nutrition (TPN) at End of Life

For patients who have been on total parenteral nutrition (TPN) — whether for gut failure, short bowel syndrome, or another reason — the question of whether to continue TPN as illness progresses is particularly complex and personal.

TPN has a clear life-sustaining role when the underlying condition makes oral or tube feeding impossible. When serious illness progresses to a point where prolonging life is no longer the primary goal, continuing TPN deserves careful discussion:

Does TPN maintain meaningful quality of life and functional ability?
Is the burden of TPN management (nightly setup, pump alarms, dressing changes, lab monitoring) compatible with how the person wants to live?
If TPN were discontinued, what would the trajectory look like, and over what timeframe?

These are conversations for you, your family, your gastroenterologist or nutrition support team, and your palliative care team together. There are no generic answers.

Subcutaneous Infusion: An Alternative to IV Access

When IV access is discontinued but medications for symptom management are still needed, subcutaneous infusion (hypodermoclysis) provides a simple, effective alternative. A small needle placed under the skin can deliver:

Pain medications (morphine, hydromorphone)
Anti-nausea medications
Anti-anxiety medications
Medications for secretion management and agitation

Subcutaneous infusion requires no central catheter, no complex dressing care, and can be managed at home by a hospice nurse with minimal equipment. It is widely used in palliative and hospice care precisely because it allows comfort medications to be given continuously without the complexity of IV access.

See: Subcutaneous Infusion (Hypodermoclysis) for a full guide.

Removing a Catheter: What Patients Ask

Is removing my port or PICC giving up?

No. Removing a device that is no longer serving a therapeutic purpose is not giving up on life or on treatment. It is choosing care that aligns with what matters to you. Many patients who have catheters removed in a palliative context describe a feeling of liberation — fewer care tasks, fewer restrictions, more freedom.

What if I change my mind?

Goals of care and the decisions that flow from them are not irreversible. If you remove a PICC but your situation changes — symptoms emerge that require IV access, or your condition stabilizes in an unexpected way — new access can be placed if consistent with your then-current goals. Talk to your care team about how to proceed if circumstances change.

Does removing the catheter mean I will die sooner?

Removing a catheter that is no longer providing therapeutic benefit does not hasten death. What determines the trajectory of serious illness is the underlying disease, not the presence or absence of a catheter that has served its purpose.

Who removes it?

A nurse can remove a PICC at home. Port removal and tunneled catheter removal require a minor procedure (port removal) or bedside procedure (tunneled catheter removal) by appropriate clinical personnel. Your care team will arrange this.

Having the Conversation with Your Care Team

Starting conversations about goals of care and vascular access decisions can feel daunting. Some approaches that help:

Be direct. “I want to talk about whether my PICC is still helpful for me” is a completely appropriate thing to say to your care team. Clinicians welcome these conversations.

Ask what the catheter is currently being used for. Sometimes patients assume a catheter is being used for more than it actually is. Clarifying what would actually change if it were removed can simplify the decision.

Ask about the palliative care team. If you have not already been introduced to the palliative care service, ask your primary team for a referral. Palliative care specialists are experts in exactly these conversations. They are not only for patients who are dying — they are for anyone with serious illness who wants expert support in managing symptoms and aligning care with what matters most.

Involve who matters to you. Bring a family member, a trusted friend, or an advocate to these conversations if that helps you.

Write down your priorities. “What I care most about is…” — completing that sentence for yourself before a care meeting helps ensure the conversation is anchored to what matters to you.

Role of the Palliative Care Team

The palliative care team — which may include physicians, nurses, social workers, chaplains, and others — specializes in:

Symptom management (pain, breathlessness, nausea, anxiety)
Conversations about goals of care
Supporting patients and families through difficult decisions
Coordinating care that aligns with patient values

They work alongside your primary care team — they do not replace your oncologist, cardiologist, or other specialists. Involving palliative care earlier rather than later leads to better symptom control, fewer unwanted interventions, and sometimes, paradoxically, longer life in some populations.

This guide is for educational purposes and reflects general principles. Decisions about vascular access, IV fluids, and goals of care are deeply personal and depend on individual clinical, personal, and cultural factors. Your palliative care team, primary care providers, and the people who know you best are the right partners for these decisions.