Vascular Access Grafts in Cancer Chemotherapy

Abstract

Starting an IV on an oncology patient who has had repeated chemotherapy infusions is often a challenge. The number of infusions usually required in a treatment regimen and the caustic nature of the drugs administered irritate and exhaust the patient's veins, causing discomfort and emotional stress. Although minute vessels have been skillfully cannulated with small-gauge butterfly needles, long courses of chemotherapy limit the use of these tiny vessels. To provide continued vascular access, a totally subcutaneous arteriovenous shunt has proved beneficial for those patients who have no readily accessible veins. To date, from 75 to 100 patients at the M.D. Anderson Hospital and Tumor Institute, Houston, receive chemotherapy through venous access grafts. Vascular access grafts made of Dacron or polytetrafluoroethylene were first used with hemodialysis patients in 1972 and proved to have distinct advantages(1). With these grafts, there are fewer infections, fewer thromboses, and comparable longevity to grafts made of other materials. These advantages are thought to be due to the fibrous con-