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Administration of chemotherapeutic agents

Techniques and controversies

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Abstract

Safe and pain-free vascular access is now the achievable goal for every patient receiving systemic chemotherapy. The discomfort and anxiety that used to accompany multiple (often unsuccessful) venipunctures can be avoided by placement of a longterm central-venous-access device as part of the patient's early treatment plan. In the United States, approximately 5x105 such devices are now inserted each year. This review discusses and compares the different types of devices currently available, methods of insertion, and management of morbidity. Future studies should focus on the cost effectiveness of these devices, better selection of patients for the various types of access, and avoidance, recognition, and treatment of complications.

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References

  1. Aitken DR, Minten JP (1984) The “pinch-off” sign: a warning of impending problems with permanent subclavian catheters. Am J Surg 148:633–636

    Google Scholar 

  2. Bour ES, Weaver AS, Yang HC (1990) Experience with the double lumen silastic catheter for hemoaccess. Surg Gynecol Obstet 171:33–39

    Google Scholar 

  3. Broadwater JR, Henderson MA, Bell JL, et al (1990) Outpatient percutaneous central venous access in cancer patients. Am J Surg 160:676–680

    Google Scholar 

  4. Brothers TE, Von Moll LK, Niederhuber JE, et al (1988) Experience with subcutaneous infusion ports in three hundred patients. Surg Gynecol Obstet 166:295–301

    Google Scholar 

  5. Broviac JW, Cole JJ, Scribner BH (1973) A silicone rubber right atrial catheter for prolonged parenteral alimentation. Surg Gynecol Obstet 136:602–606

    Google Scholar 

  6. Cathcart-Rake WF, Mowery WE (1991) Intiapericardial infusion of 5-fluorouracil. An unusual complication of Hickman catheter. Cancer 67:735–737

    Google Scholar 

  7. Chakravarthy A, Edwards WD, Fleming R (1987) Fatal tricuspid valve obstruction due to a large infected thrombus attached to a Hickman catheter. JAMA 257:801–803

    Google Scholar 

  8. Cohen AM, Wood WC (1982) Simplified technique for placement of long term central venous silicone catheters. Surg Gynecol Obstet 154:721–724

    Google Scholar 

  9. Drakos PE, Nagler A, Or R, et al (1992) Low molecular weight heparin for Hickman catheter-induced thrombosis in thrombocytopenic patients undergoing bone marrow transplatation. Cancer 70:1895–1898

    Google Scholar 

  10. Ducatman BS, McMichan JC, Edwards WD (1985) Catheter-induced lesions of the right side of the heart. A one-year prospective study of 141 autopsies. JAMA 253:791–795

    Google Scholar 

  11. Dunn J, Nylander W, Richie R (1987) Central venous dialysis access: experience with a dual-lumen silicone rubber catheter. Surgery 102:784–788

    Google Scholar 

  12. Ellis LM, Vogel SB, Copeland EM III (1989) Central venous catheter vascular erosions. Diagnosis and clinical course. Ann Surg 209:475–478

    Google Scholar 

  13. Flowers RH III, Schwenzer KJ, Kopel RF, et al (1989) Efficacy of an attachable subcutaneous cuff for the prevention of intravascular catheterrelated infection. JAMA 261:878–883

    Google Scholar 

  14. Gallina EJ (1993) Practical guide to chemotherapy administration for physicians and oncology nurses. In: DeVita VT Jr, Hellman S, Rosenberg SA (eds) Cancer principles and practice, 4th edn. Lippincott, Philadelphia, pp 2570–2580

    Google Scholar 

  15. Gebarski SS, Gebarski KS (1984) Chemotherapy port “twiddler's syndrome”. Cancer 54:38–39

    Google Scholar 

  16. Goodman MS, Wickham R (1984) Venous access devices: an overview. Oncol Nurs Forum 11:16–23

    Google Scholar 

  17. Groeger JS, Lucas AB, Coit D (1991) Venous access in the cancer patient. Princ Pract Oncol: PPO Updates 5:1–14

    Google Scholar 

  18. Groeger JS, Lucas AB, Coit D, et al (1993) A prospective, randomized evaluation of the effect of silver impregnated subcutaneous cuffs for preventing tunneled chronic venous access catheter infections in cancer patients. Ann Surg 218:206–210

    Google Scholar 

  19. Hickman RO, Buckner CD, Clift RA, et al (1979) A modified right atrial catheter for access to the venous system in marrow transplant recipients. Surg Gynecol Obstet 148:871–875

    Google Scholar 

  20. Jenkins J, Sugarbaker PH, Gianola FJ, Myers CE (1982) Technical considerations in the use of intraperitoneal chemotherapy administered by Tenchhoff cathetef. Surg Gynecol Obstet 154:858–864

    Google Scholar 

  21. Kashuk JL, Penn I (1984) Air embolism after central venous catheterization. Surg Gynecol Obstet 159:249–252

    Google Scholar 

  22. Lawson M, Bottino JC, Hurtubise MR, McCredie KB (1982) The use of urokinase to restore the patency of occluded central venous catheters. Am J Intraven Ther Clin Nutr 9:29–32

    Google Scholar 

  23. Lokich JJ, Bothe A, Benotti P, Moore C (1985) Complications and management of implanted venous access catheters. J Clin Oncol 3:710–717

    Google Scholar 

  24. Maki D, Cobb L, Garman JK, et al (1988) An attachable silver-impregnated cuff for prevention of infection with central venous catheters: a prospective randomized multicenter trial. Am J Med 85:307–314

    Google Scholar 

  25. Markman M, Cleary S, Howell SB, Lucas WE (1986) Complications of extensive adhesion formation after intraperitoneal chemotherapy. Surg Gynecol Obstet 162:445–448

    Google Scholar 

  26. Markman M, Reichman B, Hakes T, et al (1993) Intraperitoneal chemotherapy in the management of ovarian cancer. Cancer 71:1565–1570

    Google Scholar 

  27. McDonnell PJ, Qualman SJ, Hutchins GM (1984) Bilateral hydrothorax as a life-threatening complication of central venous hyperalimentation. Surg Gynecol Obstet 158:577–579

    Google Scholar 

  28. Merritt RJ, Mason W (1988) Catheter-associated infections — 1988. Nutrition 4:247–249

    Google Scholar 

  29. Mirro J Jr, Rao BN, Stokes DC, et al (1989) A prospective study of Hickman/Broviac catheters and implantable ports in pediatric oncology patients. J Clin Oncol 7:214–222

    Google Scholar 

  30. Moore C, Heffernan I, Sheldon S (1992) Diagnosis and management of subclavian vein thrombosis. J Infus Chemother 2:151–152

    Google Scholar 

  31. Moosa HH, Julian TB, Rosenfeld CS, et al (1991) Complications of indwelling central venous catheters in bone marrow transplant recipients. Surg Gynecol Obstet 172:275–279

    Google Scholar 

  32. Moss AH, McLaughlin MM, Lempert KD, et al (1988) Use of a silicone catheter with a Dacron cuff for dialysis short-term vascular access. Am J Kidney Dis 6:492–498

    Google Scholar 

  33. Mueller BU, Skelton J, Callender DPE, et al (1992) A prospective randomized trial comparing the infectious and noninfectious complications of an externalized catheter versus a subcutaneously implanted device in cancer patients. J Clin Oncol 10:1943–1948

    Google Scholar 

  34. Niederhuber JE, Ensminger W, Gyves JW, et al (1982) Totally implanted venous and arterial access system to replace external catheters in cancer treatment. Surgery 92:706–712

    Google Scholar 

  35. Noyen J, Hoorntje J, Langen Z de, et al (1987) Spontaneous fracture of the catheter of a totally implantable venous access port: case report of a rare complication. J Clin Oncol 5:1295–1299

    Google Scholar 

  36. Ozols RF (1991) Intraperitoneal therapy in ovarian cancer: time's up. J Clin Oncol 9:197–199

    Google Scholar 

  37. Pasquale MD, Campbell JM, Magnant CM (1992) Groshong versus Hickman catheters. Surg Gynecol Obstet 174:408–410

    Google Scholar 

  38. Raaf JH (1985) Results from use of 826 vascular access devices in cancer patients. Cancer 55:1312–1321

    Google Scholar 

  39. Raaf JH (1985) New venous access techniques in cancer patients. Direct Oncol 1:1–12

    Google Scholar 

  40. Raaf JH (1989) An atraumatic tunneling device for implantation of right atrial catheters and ports. Surg Gynecol Obstet 168:353–354

    Google Scholar 

  41. Raaf JH (1991) Vascular access, catheter technology and infusion pumps. In: Moossa AR, Schimpff SC, Robson MC (eds) Comprehensive textbook of oncology, 2nd edn. Williams & Wilkins, Baltimore, pp 583–589

    Google Scholar 

  42. Raaf JH, Heil D (1993) Open insertion of right atrial catheters through the jugular veins. Surg Gynecol Obstet 177:295–298

    Google Scholar 

  43. Raaf JH, Heil D, Rollins DL (1994) Vascular access, pumps, and infusion. In: McKenna RJ, Murphy GP (eds) Cancer surgery. Lippincott, Philadelphia, pp 47–62

    Google Scholar 

  44. Raucher HS, Hyatt AC, Barzilai A, et al (1984) Quantitative blood cultures in the evaluation of septicemia in children with Broviac catheters. J Pediatr 104:29–33

    Google Scholar 

  45. Ross MN, Haase GM, Poole MA, et al (1988) Comparison of totally implanted reservoirs with external catheters as venous access devices in pediatric oncologic patients. Surg Gynecol Obstet 167:141–144

    Google Scholar 

  46. Rudolph R, Larson DL (1987) Etiology and treatment of chemotherapeutic agent extravasation injuries: a review. J Clin Oncol 5:1116–1126

    Google Scholar 

  47. Sariego J, Bootorabi B, Matsumoto T, Kerstein M (1993) Major longterm complications in 1422 permanent venous access devices. Am J Surg 165:249–251

    Google Scholar 

  48. Sato O, Tada Y, Sudo K, et al (1986) Arteriovenous fistula following central venous catheterization. Arch Surg 121:729–731

    Google Scholar 

  49. Schropp KP, Ginn-Pease ME, King DR (1988) Catheter-related sepsis: a review of the experience with Broviac and Hickman catheters. Nutrition 4:195–200

    Google Scholar 

  50. Scott WL (1985) Complications associated with central venous catheters. A survey. Chest 94:1221–1224

    Google Scholar 

  51. Seeger J, Woodcock TM, Richardson JD (1985) Complications of implantable chemotherapy pump. A case of pump inversion. Cancer 56:2428–2429

    Google Scholar 

  52. Stellato TA, Gauderer MW, Cohen AM (1981) Direct central vein puncture for silicone rubber catheter insertion. An alternative technique for Broviac catheter placement. Surgery 90:896–899

    Google Scholar 

  53. Treiman GS, Silberman H (1993) Chronic venous access in patients with cancer: selective use of the saphenous vein. Cancer 72:760–765

    Google Scholar 

  54. Tschirhart JM, Rao MK (1988) Mechanism and management of persistent withdrawal occlusion. Am Surg 54:326–328

    Google Scholar 

  55. Van Hoff J, Berg AT, Seashore JH (1990) The effect of right atrial catheters on infectious complications of chemotherapy in children. J Clin Oncol 8:1255–1262

    Google Scholar 

  56. Walker TG, Geller SC, Waltman AC, et al (1988) A simple technique for redirection of malpositioned Broviac or Hickman catheters. Surg Gynecol Obstet 167:246–248

    Google Scholar 

  57. Woodyard TC, Mellinger JD, Vann KG, Nissenbaum J (1993) Acute superior vena cava syndrome after central venous catheter placement. Cancer 71:2621–2623

    Google Scholar 

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  1. Cleveland VA Medical Center, Case Western Reserve University, 10701 East Boulevard, 44106, Cleveland, OH, USA

    John H. Raaf

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Raaf, J.H. Administration of chemotherapeutic agents. Support Care Cancer 2, 335–346 (1994). https://doi.org/10.1007/BF00344046

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