Central Venous Catheter Care for the Patient With Cancer: American Society of Clinical Oncology Clinical Practice Guideline

Abstract

There is insufficient evidence to recommend one CVC type or insertion site; femoral catheterization should be avoided. CVC should be placed by well-trained providers, and the use of a CVC clinical care bundle is recommended. The use of antimicrobial/antiseptic-impregnated and/or heparin-impregnated CVCs is recommended to decrease the risk of catheter-related infections for short-term CVCs, particularly in high-risk groups; more research is needed. The prophylactic use of systemic antibiotics is not recommended before insertion. Data are not sufficient to recommend for or against routine use of antibiotic flush/lock therapy; more research is needed. Before starting antibiotic therapy, cultures should be obtained. Some life-threatening infections require immediate catheter removal, but most can be treated with antimicrobial therapy while the CVC remains in place. Routine flushing with saline is recommended. Prophylactic use of warfarin or low-molecular weight heparin is not recommended, although a tissue plasminogen activator (t-PA) is recommended to restore patency to occluded catheters. CVC removal is recommended when the catheter is no longer needed or if there is a radiologically confirmed thrombosis that worsens despite anticoagulation therapy.

Sepsis in head and neck cancer patients treated with chemotherapy and radiation: Literature review and consensus

“…In addition, ASCO guidelines [137] • Regarding the enteral nutrition, there were significantly more infections in the PEG group (66%) compared to the NGT group (30%) p = 0.001 in the prospective study of Corry et al [124], but the difference of pneumonia between the two groups (PEG = 31.3% vs. NGT = 30%) was statistically insignificant. In fact, the majority of infections in the PEG group were at the PEG site (31%: 10/32).…”

“…Cancer patients with implantable port systems experienced a median of 0.2 infections per 1000 catheter-days (range: 0-2.7 per 1000 catheter-days) [134] versus a risk that ranges from 1.4 to 2.2 infections per 1000 catheter-days for subcutaneous tunneled CVCs [135,136]. Nevertheless, this difference may be biased by the fact that patients who receive implantable subcutaneous ports usually receive much less intensive cancer therapy [137]. Thus, the optimal device to be used during CRT is hardly advisable and needs further prospective trials.…”

Bedside Procedure: Retained Central Venous Catheter

“…Flushes are usually a sterile saline or heparin saline solution which is injected to fill the catheter. If an institution utilizes heparin saline for flushes, care should be exercised to identify patients with contraindications to heparin such as history of hypersensitivity reaction, and heparin-induced thrombocytopenia (HIT) [17][18][19]. There are many devices available for central venous access but they are generally composed of silicone or polyurethane which allows for relative stiffness at room temperature and a softened state at body temperature [6,11].…”

Complicações infecciosas associadas ao cateter venoso central totalmente implantável

“…22 In this study, articles that evaluated this place of insertion regarding the risk of infections were not included. , catheter-related infection 9,11,16 and infection of the subcutaneous pouch 20 were the most prevalent infections in the studies, with a predominance of gram-negative bacteria, such as Staphylococcus aureus 12,14,16,19,20 and Sthaphylococcus epidermis.…”