Chronic venous access in patients with cancer. Selective use of the saphenous vein.

Abstract

Dependable chronic venous access is an important aspect of supportive care for patients requiring chemotherapy or other long-term therapy because it enables such patients to be treated on an outpatient basis. The authors studied 56 patients with cancer requiring chronic venous access who had an infusion catheter placed into the inferior vena cava (IVC) through open saphenous venotomy, most commonly because superior vena cava (SVC) occlusion, severe chest wall infection, or chest wall malignancy precluded standard subclavian or jugular cannulation. The 56 catheters were in place for 12-550 days. The overall complication rate was 0.30 complications per 100 catheter-days. Thirty-six patients (64%) had no complications. Among the remaining 20 patients, 8 (14.3%) had a local infection, 2 (3.6%) had systemic bacteremia, and 10 had lower extremity edema, including 9 patients (16.1%) in whom the IVC was thrombosed. Twelve of the 20 complications were treated successfully without catheter removal. Thus, in 86% (48 of 56) of patients, the catheter was effective for as long as infusion therapy was required. Venous cannulation through the saphenous vein is a useful method of achieving and maintaining chronic venous access in patients in whom the subclavian or jugular veins are unavailable.