Types Of Venous Access Devices Research Articles

OP143 Association Of Different Venous Access Device With Health‑Related Quality Of Life Among Patients With Breast Cancer In China

IntroductionFew studies have explored the relationship between different venous access devices and health-related quality of life (HRQoL) among patients with breast cancer in China. This study aimed to evaluate the HRQoL of patients with breast cancer in China who underwent different venous access devices and to estimate the association between type of venous access device and HRQoL.MethodsA multicenter cross-sectional study was conducted in three tertiary hospitals from three major geographical regions in China. The final sample consisted of 472 patients aged from 18 to 78 years. The HRQoL was measured with the EQ-5D-5L scale and the EuroQoL Group visual analog scale. The venous access devices were divided into totally implantable venous access devices (TIVAD), peripherally inserted central catheters (PICC), and other devices. The multivariate regression analyses were used to explore the association between type of venous access device and HRQoL.ResultsOf 472 participants, 352 (75%) used the TIVAD device, 89 (19%) used the PICC device, and 31 (7%) used other devices. The TIVAD group had the highest EQ-5D-5L values (mean 0.89, standard deviation [SD] 0.178), while the PICC group had the lowest values (mean 0.85, SD 0.239). The EQ-5D-5L values for the other venous access device group was in between (mean 0.88, SD 0.127). However, the multivariate analysis indicated that the VAS and EQ-5D-5L scale dimension scores among patients were not significantly different (P>0.05) for the various central venous access devices.ConclusionsThis study demonstrates a non-significant association between the type of venous access device used and the HRQoL of patients with breast cancer in China. Although patients with a TIVAD experienced more pain during device insertion and access for chemotherapy, the negative effect on HRQoL scores was smaller than for PICCs.

Administration of intravenous fluids and medicines in children and young people.

Managing intravenous (IV) access is a standard proficiency for UK nurses, enabling them to administer IV injections and IV infusions and to manage injection equipment and infusion pumps and devices. In this article the author describes various types of venous access devices that are commonly seen in practice and details the preparation, checking and administration of IV fluids and medicines, including some complications that may arise. The author also discusses the calculation of fluid requirements, types of IV fluids, displacement values and ongoing care of venous access devices.

Rapid Superficial Vein Assessment (RaSuVA): A pre-procedural systematic evaluation of superficial veins to optimize venous catheterization in neonates.

Placement of peripheral intra-venous cannulas and epicutaneo-caval catheters is routinely performed in in Neonatal Intensive Care Unit (NICU), and both devices require visible superficial veins easy to cannulate. NICU patients are intrinsically characterized by poor and fragile vein asset, so that puncture and cannulation of superficial veins is often a challenge even for trained clinicians and cannulation frequently results in a stressful, painful, difficult procedure. Rapid Superficial Vein Assessment is meant to offer a systematic pre-procedural evaluation of all superficial veins of the newborn, so to allow a rational choice of the best insertion site, tailored on the single patient, and optimized for the specific type of venous access device. The superficial veins are examined systematically, both with and without NIR technology, exploring seven skin areas in the following order: (1) medial malleolus, (2) lateral malleolus, (3) retro-popliteal fossa, (4) back of the hand and wrist, (5) antecubital fossa, (6) anterior scalp surface, and (7) posterior scalp surface. The aim of the protocol is to increase the first attempt success rate and reduce the duration of the procedure, the number of attempts for single patient and possibly to limit complications, stress, and pain in neonates.

Comparative Complication Rates of 854 Central Venous Access Devices for Home Parenteral Nutrition in Cancer Patients: A Prospective Study of Over 169,000 Catheter-Days.

Whether peripherally inserted central catheters (PICCs) are appropriate as safe and durable venous access devices (VADs) is still controversial. The aim of this 7-year, prospective cohort study was to compare the incidence rate differences of catheter-related complications (CRCs) among 4 types of central VADs in cancer patients receiving home parenteral nutrition (HPN). We enrolled all adult cancer outpatients who were candidates for HPN and who had a central VAD inserted during the study period, focusing on the incidence rate of CRCs. We evaluated 854 central VADs (401 PICCs, 137 nontunneled centrally inserted central catheters [CICCs], 118 tunneled-cuffed CICCs, and 198 ports) in 761 patients, for a total of 169,116 catheter-days. Overall, the rate of total CRCs was 1.08/1000 catheter-days. The incidence of catheter-related bloodstream infections was low (0.29/1000), particularly for PICCs (0.08/1000; P < .001 vs tunneled-cuffed CICCs) and for ports (0.21/1000; P < .019 vs tunneled-cuffed CICCs). The rates of mechanical complications (0.58/1000) and of catheter-related symptomatic thrombosis (0.09/1000) were low and similar for PICCs, tunneled-cuffed CICCs, and ports. In terms of duration and removal rate due to complications, PICCs were like tunneled-cuffed CICCs and ports. Altogether, PICCs had fewer total complications than tunneled-cuffed CICCs (P < .001), there was no difference in total complications between PICCs and ports. PICCs had significantly better outcomes than tunneled-cuffed CICCs and were safe and durable as ports. Our extensive, long-term study suggests that PICCs can be successfully used as safe and long-lasting VADs for HPN in cancer patients.

AVATAR®: an electronic evidence-based medicine friendly tool for vascular access planning.

In today's demanding healthcare setting, many patients who are referred to hospital for treatment require some form of intravascular access device to administer required therapies and medications. It is estimated that most of admissions have an intravascular device placed on arrival to any given facility. Often these treatment prerequisites, combined with a wide range of available devices, based upon a combination of patient assessments, necessitated treatment regimens, and the use of a decision algorithm to choose the most appropriate device that provides all the patient's needs, requires a logical and methodical approach during the decision-making process. Several criteria should always remain in high regard for patient and device considerations, such as overall need for a device, the type of drugs or medications being infused, duration of therapy, patient disease states and comorbidities, as well as vessel health, patient age, previous intravascular device history, patient preference, potential site(s) of implantation, and finally, the resources available for ongoing device management. We have developed a tool, called AVATAR, aimed to make easier the implementation of a vascular access planning. It is a newly-designed tool, developed for the clinicians that must decide which type of venous access device is the ideal one in each single patient. It utilizes existing information that may not necessarily be only used by experts, but mainly by any clinician who may be looking for assistance in determining patient requirements. It requires clinical knowledge and it is not designed to be used for determining vascular access choices in emergency situations.

Navigating venous access: a guide for hospitalists.

Venous access is the foundation for safe and effective hospital-based care. Inpatient providers must have a deep knowledge of the different types of venous access devices (VADs), their relative indications, contraindications, and appropriateness. However, such knowledge is difficult to come by and usually only gleaned through years of clinical experience. To bridge this gap, we provide an in-depth summary of the relevant anatomical considerations, physical characteristics, advantages, and disadvantages of VADs commonly used in the hospital setting. In doing so, we seek to improve the safety and share the science of vascular access with frontline clinicians. To aid decision-making, we conclude by operationalizing the available data through algorithms that outline appropriate vascular access for the hospitalized patient.

Abstract P4-12-11: Patient preference for subcutaneous trastuzumab via handheld syringe versus intravenous infusion in HER2-positive early breast cancer: Cohort 2 of the PrefHer study

Abstract Background In the HannaH study (NCT00950300), a 600 mg fixed dose of subcutaneous (SC) trastuzumab, administered via handheld syringe, was shown to have noninferior efficacy and comparable pharmacokinetic and safety profiles to the intravenous (IV) formulation for the (neo)adjuvant treatment of HER2-positive early breast cancer. Cohort 1 of the ongoing, randomized, multicenter, international, crossover PrefHer study (NCT01401166) showed that an overwhelming 92% of patients preferred SC trastuzumab via single-use injection device to conventional IV administration. The objective of the current analysis was to assess patient preferences for SC or IV trastuzumab in Cohort 2 of PrefHer, an independently assessed cohort in which SC trastuzumab was administered via handheld syringe. Methods After completing (neo)adjuvant chemotherapy, patients were randomized to receive 4 cycles of SC trastuzumab (fixed dose of 600 mg) followed by 4 cycles of IV trastuzumab (8 mg/kg→6 mg/kg) or the reverse sequence (the crossover period) as part of their adjuvant trastuzumab therapy. The primary endpoint was the proportion of patients indicating an overall preference for SC versus IV trastuzumab, assessed using a two-sided test against the null hypothesis of 65% preference for SC. Prior to randomization and again at the end of the crossover period, experienced interviewers conducted telephone interviews with patients. Information on factors potentially influencing preferences, including type of venous access device used and experiences during administration, was collected. After the crossover period, patients’ final preferences were elicited, along with reasons for these and the strength of them. Interviews were stringently quality-controlled to ensure impartial questioning. Four researchers independently coded from verbatim quotes the two primary reasons patients gave for their preferences. These were reconciled and grouped into ten categories for descriptive analyses. Adverse events (AEs) were assessed by standard methods. Results Two hundred and forty patients were enrolled: 231 received SC and IV trastuzumab and completed both patient interviews, and 239 received ≥1 dose of study drug. Baseline demographics/characteristics/treatment histories were generally balanced. SC trastuzumab was preferred by 199/231 patients (86%, 95% CI 81–90%; p&amp;lt;0.0001); 29 preferred IV (13%, 95% CI 9–18%), and 3 had no preference (1%, 95% CI 0–4%). Of the patients who preferred SC, overall preferences were “very strong” in 144/199 (72%), “fairly strong” in 36 (18%), and “not very strong” in 19 (10%). The two primary categories for SC preference were: i) time saving and ii) less pain/discomfort. AEs were reported in 77% of patients during the crossover period (69% mild, 36% moderate, 8% severe, 0% life-threatening/fatal, 1% serious). Overall safety was comparable with the known IV profile in early breast cancer. Summary As with Cohort 1, patients in Cohort 2 of the PrefHer study overwhelmingly preferred SC over IV trastuzumab delivery. The 4 cycles of SC trastuzumab and 4 of IV were well tolerated. SC trastuzumab is therefore an important option in the treatment of HER2-positive early breast cancer. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-12-11.

Catheter‐Related Complications in Cancer Patients on Home Parenteral Nutrition

Although home parenteral nutrition (HPN) is often indicated in cancer patients, many physicians are concerned about the risks potentially associated with the use of central venous access devices (VADs) in these patients. The aim of this prospective study was to investigate the actual incidence of VAD-related complications in cancer patients on HPN. All adult cancer patient candidates for VAD insertion and HPN were enrolled. The incidence of complications associated with 4 types of VADs (peripherally inserted central catheter [PICC], Hohn catheter, tunneled Groshong catheter, and port) was investigated, as well as the most significant risk factors. Two hundred eighty-nine VADs in 254 patients were studied, for a total of 51,308 catheter-days. The incidence of catheter-related bloodstream infections (CRBSIs) was low (0.35/1000 catheter-days), particularly for PICCs (0/1000; P < .01 vs Hohn and tunneled catheters) and for ports (0.19/1000; P < .01 vs Hohn and P < .05 vs tunneled catheters). Mechanical complications were uncommon (0.8/1000), as was VAD-related venous thrombosis (0.06/1000). Ultrasound-guided venipuncture was associated with a decreased risk of CRBSI (P < .04) and thrombosis (P < .001). VAD securement using sutureless devices reduced the risk of CRBSI and dislocation (P < .001). Hohn catheters had no advantage over PICCs (higher complication rate and shorter dwell time; P < .001). In cancer patients, HPN can be safely carried out with a low incidence of complications. Also, VADs are not equal in terms of complication rates, and strict adherence to meticulous insertion policies may effectively reduce catheter-related complications.

A guide to the use and care of vascular access devices in the palliative care setting

There has been a steady increase in the number and range of vascular access devices used in all areas of health care. With this increase there comes a requirement that health professionals dealing with these devices be aware of the range available, indications for use, and the most up to date guidance on the care and maintenance procedures. Care of the device is paramount to preventing complications. This article provides an overview of the types of venous access devices that may be encountered when a patient is transferred to palliative care services, as well as of the procedures for routine maintenance.

Factors Associated with Central Venous Catheterization in Cancer Patients

Purpose: The purpose of this study was to identify the types of venous access devices (VAD) for cancer patients and investigate the factors related to the insertions of central venous catheter (CVC) in cancer patients. Methods: The subjects were 379 cancer patients. A retrospective review of all patients who were discharged from a cancer unit from November 1st to 21st in 2008 was done using a structured questionnaire. Results: A total of 82 CVC (21.6%) was inserted among 379 patients for administering anticancer therapy. There were statistically significant differences in age, length of stay (LOS), cumulative LOS, medical department, history of CVC insertion, cancer category, and albumin level between patients using peripheral intravenous (IV) catheters and CVC. In addition, factors influencing the use of CVC were LOS (odds ratio [OR]=0.286, confidence interval [CI]=1.043-1.124), history of CVC insertion (OR=3.920, CI=0.128-0.637), albumin level (OR=1.010, CI=1.879-8.179), cumulative LOS (OR=1.010, CI=1.001-1.018), and hematological diseases (OR=4.863, CI=2.162-10.925). Conclusion: We found that central venous catheterization for anticancer therapy was minimal even though CVC was safe and effective device for Ⅳ access. It is necessary to develop a strategy to use VADs efficiently and timely for cancer patients.

Establishing a programme for continuous ambulatory infusion chemotherapy.

The development of venous access devices (VADs) and portable infusion pumps has enabled chemotherapy to be administered continuously within the home environment. The objective of this study was to describe the experience of establishing an ambulatory chemotherapy programme for patients receiving protracted infusions (PVIs) of 5-fluorouracil (5-FU). The files of all patients receiving PVI 5-FU as a component of their treatment for gastrointestinal malignancy were reviewed. The types of VADs, infusion pump systems and their management were documented. Information packages and education programmes were developed for patients. Seventy-four patients with gastrointestinal cancer were studies. At the end of the period the Portacath was the preferred VAD, while both pumps used were found to have advantages and disadvantages. The choice of pump was decided more by patient preference than systematic differences in performance of the pumps. The findings in this review confirm that, with close attention to the potential pitfalls of ambulatory chemotherapy, an acceptable service can be provided.

Comparison of vascular access devices

To provide an overview of venous access device designs and methods of insertion and removal. Venous access devices are indicated for many patients who require reliable long-term venous access. Three types of venous access devices are available including nontunneled, tunneled, and implanted ports. Since their introduction into clinical practice, the widespread use of these devices has had an enormous impact on cancer treatment by decreasing the overuse of peripheral veins while allowing for more flexibility and choice of the type of device used. Although numerous devices are available, each offers unique designs and performance expectations. Each type of device has similar features and can be used for intravenous drug and nutritional therapy, administration of blood products, and withdrawal of blood. Even if only a single device is used in a given setting, the nurse must have a basic understanding of all types of venous access devices. It is imperative that the nurse be fully cognizant of the anatomic position and structure of the major vessels associated with the central venous system, especially for the insertion of peripheral central catheters. Understanding the venous system and venous access design can assist in preventing or assessing potential complications.