[Implantable direct intravenous access: technic, complications, outcome. Apropos of 237 cases]

From june 1983 to december 1987, 441 direct accesses were implanted, 237 intravenous, 51 intraperitoneal and 153 intra-arterial. The surgical procedure, the indications, the post-operatory and later complications and the issue of the direct intravenous accesses implanted by the same surgical team are presented. 237 direct access implants were placed intravenously in 228 patients. There are many indications for implanting direct access: absence of a superficial venous network, continuous chemotherapy, preservation of the superficial venous network, thrombosis of the hepatic artery after, inoperable hepatic metastasis (jaundice). Direct venous access was implanted for many pathologies essentially for breast cancer (120 cases), large bowel cancer (36 cases). Surgical procedure for direct intravenous access is easy with catheter's control with fluoroscopy monitoring. Only rarely did any later complication occur when using the direct intravenous access (12 cases) representing 5% of all complications. Certain precautions should be taken to reduce the number of complications. Prophylactic antibiotic therapy, surgical procedure for implanting the direct access excision of excess fatty subcutaneous tissue, minutious skin disinfection, heparinization, avoid using the chamber for blood sampling, use intra-arterial direct access. Direct access is used either for sequential chemotherapy or for continuous protocols which vary in length.