Vascular Access in Oncology Patients

Abstract

Adequate vascular access is of paramount importance in oncology patients. It is important in the initial phase of surgical treatment or chemotherapy, as well as in the chronic management of advanced cancer and in the palliative care setting. We present an overview of the available vascular access devices and of the most relevant issues regarding insertion and management of vascular access. Particular emphasis is given to the use of ultrasound guidance as the preferred technique of insertion, which has dramatically decreased insertion-related complications. Vascular access management has considerably improved after the publication of effective guidelines for the appropriate nursing of the vascular device, which has reduced the risk of late complications, such as catheter-related bloodstream infection. However, many areas of clinical practice are still lacking an evidence-based background, such as the choice of the most appropriate vascular access device in each clinical situation, as well as prevention and treatment of thrombosis. We suggest an approach to the choice of the most appropriate vascular access device for the oncology patient, based on the literature available to date. (CA Cancer J Clin 2008;58:323-346.)

Exploring Attitudes towards a Randomised Controlled Trial of Venous access Devices – a Nested Pre-trial Qualitative Study

“…The search covered two main areas of research: firstly, patient and clinical staff attitudes to RCTs and secondly, patient and clinical staff attitudes to venous access devices. Many qualitative studies have explored the views of cancer patients to the process of RCTs, exploring informed consent (12,13), understanding of equipoise (14), randomisation (15), recruitment (13,14,16) and participation in trial design (17). Despite this, recent research reveals health professionals' discomfort at approaching patients to discuss participation in an RCT at an already stressful period for the patient (17).…”

An Entirely Echo-Guided Technique for Totally Implantable Access Port Positioning

“…Results from the largest published series of consecutive patients with cancer undergoing CVC insertion under US guidance indicate that such technique should be mandatory for central venous insertion in patients, especially in the more seriously ill ones [14,15]. When using the blind technique, incidence of axillary vein or right atrial catheter malposition is 14 % and clinical signs alone will not reliably identify malpositioned catheters [16].…”

Revisión sistemática de las complicaciones de los dispositivos de administración de tratamiento al paciente oncológico

“…Los pacientes oncológicos son más propensos a ellas que otro tipo de paciente debido a su inmunosupresión (15) .…”

“…La retirada del catéter, la administración de una solución antimicrobiana de sellado del catéter ("lock" terapia) y el comienzo del tratamiento antibiótico sistémico son algunos procedimientos para el manejo de estas infecciones (15,19) . La retirada del dispositivo es una alternativa que se ha de considerar.…”

“…En el caso de los CCIP, el catéter debe ser retirado cuando hay una complicación infecciosa o sospecha de ella. Al contrario ocurre con los Port-A-Cath, ya que se deben evaluar algunos factores para su retirada (evaluación de la gravedad del estado de salud del paciente, una prueba de que el catéter está infectado, disponibilidad de canalizar otro acceso venoso, evaluación del patógeno y presencia de otras complicaciones graves) (15) . El tratamiento antibiótico sistémico debe comenzarse en todos los casos y, en ocasiones, podría asociarse con la "lock" terapia, en la cual los antibióticos usados deben ser compatibles con el catéter usado y con otros componentes de la terapia, como son la heparina, el suero fisiológico y otros antibióticos (19,20) .…”