Vascular access problems revisited: the Multinational Association of Supportive Care in Cancer (MASCC) experience

Despite the increased availability of vascular access devices, there is limited information regarding their pattern of use in the clinical setting or the criteria used for their utilization. To obtain this information, we sent questionnaires to MASCC members. Forty-five percent of the respondents stated that the decision to use vascular access devices depended on the drugs used at the beginning of therapy. Another 30% replied that the decision to use long-term vascular access devices depended on the status of the patient's veins at the beginning of therapy. Only 12% of those surveyed waited until all the veins were exhausted before considering using vascular access devices. Although more than half of the professionals surveyed used long-term vascular access devices in 50% or more of their patients with hematologic malignancies, only 20% used these devices in patients with solid tumors. Features considered most important when selecting long-term vascular access devices were durability of the device and ease of use for medical personnel. Major limitations of long-term vascular access devices were cost, closely followed by patient acceptance. The most common reasons for removal of vascular access devices were infection and thrombosis. We conclude that there is a lack of uniform criteria for the utilization of long-term vascular access devices. Cost is a major limitation to the wider use of this technology. More research is necessary to determine the optimal use of vascular access devices in patients with cancer.