Results from use of 826 vascular access devices in cancer patients

Vascular access technology is rapidly improving. Over the last 7 years we evaluated 826 access devices in 681 patients with neoplastic disease. The devices included 103 polytetrafluoroethylene (PTFE) arteriovenous (A-V) grafts, 358 Broviac 2.2-mm and 135 Hickman 3.2-mm right atrial catheters, 161 2.2-mm and 44 4.5-mm dual-lumen right atrial catheters, 12 venous infusion ports, and 13 large-bore staggered-tip dual-lumen catheters. All devices provided satisfactory venous access. Twenty-eight percent of the PTFE A-V grafts eventually thrombosed, versus 0.7% of Silastic right atrial catheters (P less than 0.005). Because of its low long-term complication rate (only 7% removed or lost because of a complication) and its simplicity of insertion and use, the Silastic right atrial catheter is now our preferred device. Most patients receive a 2.2-mm dual-lumen catheter, the second channel of which can provide a route for parenteral nutrition or blood sampling, and is a form of "insurance" if the first lumen becomes occluded. In over 95% of patients with chemotherapy-induced neutropenia and fever or bacteremia, their right atrial catheters were not removed, rather they were used for intravenous antibiotic infusions. The new larger bore dual-lumen catheters provided effective access for acute hemodialysis or plasmapheresis, as well as for routine venous access. The infusion port was particularly suitable for administration of adjuvant chemotherapy in the outpatient department, although the complexity of its use challenged the professional staff.