THE CHOICE OF PERMANENT VENOUS ACCESS DEVICE IN ONCOLOGY

Summary:

In case that long term therapy is indicated, the choice of adequate venous access device (VAD) is a current topic in medicine. This is crucial to be engaged to this issue especially in oncology since specific anticancer therapy is performed mainly via parenteral route of administration. Permanent venous access device is used in curative, palliative or symptomatic treatment strategy. We suggest an approach to the choice of the most appropriate venous access device for the oncology patient available to date.

Patients and methods:

We analyzed the group of patients indicated for permanent VAD placement in our centers in order to find out the indications to prefer particular permanent central VAD. We have defined the most important factors in decision-making pro­cess of VAD selection.

Results:

The implementation of permanent central VAD is comfortable for patient with the reduced risk of the peripheral application complications. We appreciated the PICC insertion in chemotherapy regimens with vesicant or irritant cytostatic drugs, need for central access and frequent drug administration, in patients with mid-term therapy duration in particular, in patients in coagulopathy and for application of parenteral nutrition. The du­ration of PICC insertions was 3 months in average. PICC insertion seem to be appropriate especially for mid-term continuous fluoropyrimidine administra­tion with central access needful (squam-cell esophageal carcinoma offered for neoadjuvant concomitant radiochemotherapy, anal squam-cell carcinoma), we also enrolled patients treated for head and neck cancer in pallaitive strategy with very low risk of infectious complications. Venous port is prefered for patients with advanced malignancies with feasibility of more treatment lines and in outpatient care (e. g. ovarian cancer, breast cancer, colorectal cancer).

Conclusion:

There are patient and/or treatment-related factors need to be account in case the permanent VAD placement is planned and many different reasons for permanent VAD insertion exist. Together with implantable ports, peripherally inserted central catheters (PICCs') represent further useful type of VAD with broad spectrum of indications, especially in oncology. In case there is a treatment plan for at least 6 months, ports are implanted in general. Other specific groups of oncology patients may benefit from PICC insertions.