Challenging the distal-to-proximal cannulation technique for administration of anticancer therapies: a prospective
Raymond Javan Chan1, Alison Alexander, Maree Bransdon
1Cancer Care Services, Royal Brisbane and Women's Hospital, Queensland, Australia. r.chan2@uq.edu.au
Background:
Distal-to-proximal technique has been recommended for anticancer therapy administration. There is no evidence to suggest that a 24-hour delay of treatment is necessary for patients with a previous venous puncture proximal to the administration site.
Objectives:
This study aims to identify if the practice of 24-hour delay between a venous puncture and subsequent cannulation for anticancer therapies at a distal site is necessary for preventing extravasation.
Methods:
A prospective cohort study was conducted with 72 outpatients receiving anticancer therapy via an administration site distal to at least 1 previous venous puncture on the same arm in a tertiary cancer center in Australia. Participants were interviewed and assessed at baseline data before treatment and on day 7 for incidence of extravasation/phlebitis.
Results:
Of 72 participants with 99 occasions of treatment, there was 1 incident of infiltration (possible extravasation) at the venous puncture site proximal to the administration site and 2 incidents of phlebitis at the administration site.
Conclusion:
A 24-hour delay is unnecessary if an alternative vein can be accessed for anticancer therapy after a proximal venous puncture.
Implications For Practice:
Infiltration can occur at a venous puncture site proximal to an administration site in the same vein. However, the nurse can administer anticancer therapy at a distal site if the nurse can confidently determine that the vein of choice is not in any way connected to the previous puncture site through visual inspection and palpation.
