[Venous access in oncology]

Many treatments administered to cancer patients require venous access either via a peripheral vein or a larger central vein at the risk of local or systemic infection, thrombus formation or venous occlusion and dysfunction.

Insertion of a central catheter is an invasive procedure which must be conducted under conditions of rigorous asepsia. Strict rules based on well-defined protocols must be applied throughout its use.

Local or systemic infectious complications account for 18 to 25% of all nosocomial infections and are often related to colonisation of the puncture site by a Gram positive germ. In case of infection, ablation of the central catheter is not mandatory for diagnosis or antibiotic treatment.

Reported at varying frequencies in the literature from 4 to 42%, thrombus formation is unpredictable and often difficult to diagnose. Anticoagulants or fibrolytic agents are indicated but it may also be necessary to withdraw the catheter.

Displacement, rupture, obstruction and extravasation are frequent complications. Back flow must be checked in all venous accesses and free flow carefully verified. The access must remain patent throughout the period of use, guaranteed by a standard heparinization and rinsing protocol.

This complications must not mask the important progress achieved with the use of central venous access for specific and symptomatic treatment in cancer patients.