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| LETTER TO THE EDITOR |
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| Year : 2021 | Volume
: 4
| Issue : 4 | Page : 769-770 |
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Long-term venous access devices: A lifeline for patients with cancer
Rushabh Kothari
Oncowin Cancer Center, Narayana Multispeciality Hospital, Ahmedabad, Gujarat, India
| Date of Submission | 03-Nov-2021 |
| Date of Decision | 11-Nov-2021 |
| Date of Acceptance | 16-Nov-2021 |
| Date of Web Publication | 29-Dec-2021 |
Correspondence Address:
Rushabh Kothari
307, City Centre Arcade, Besides SRP Camp, Naroda, Ahmedabad - 382 346, Gujarat
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/crst.crst_259_21
How to cite this article:
Kothari R. Long-term venous access devices: A lifeline for patients with cancer. Cancer Res Stat Treat 2021;4:769-70 |
Venous access devices (VADs) are a necessity for oncology patients who are planned for prolonged chemotherapy schedule, infusional chemotherapy, drugs with a high risk of extravasation, and pediatric patients. Peripherally inserted central catheter (PICC) and totally implantable VAD (TIVAD) (also known as chemo port) are the two most commonly used devices for this purpose.
In the retrospective study by Chandveetil et al.[1] published in this journal, few important points have been highlighted which reflect the ground reality in low-and middle-income countries (LMICs). More usage of PICC than chemo port, more TIVADS inserted under local anesthesia, not all eligible patients undergoing TIVAD insertion, and early complications after TIVAD insertion including infections are some of them.
From the current study, the importance of a dedicated catheter clinic for catheter care, including dressing, flushing, and removal, is noted. Furthermore, the use of ultrasound for insertion, especially in difficult cases, standardization of the catheter insertion procedure and catheter care, and the effort to salvage catheters reported in this study are worth applauding.
Some important questions which can be helpful to oncologists practicing in LMICs and can be answered by the study team include: Which patients cannot be considered for TIVAD insertion under local anesthesia? How should TIVAD-related complications be identified early and how should these complications be salvaged? Can TIVAD be inserted in the upper arm?
We all know that the major hurdle for us in using TIVADs is the cost. Hence, even though complication rates are greater with PICC, we tend to use PICC more than TIVAD.[2] Performing the procedure under local anesthesia and good salvage rate can help us bring the cost down and thus increase the usage of TIVADs. There are some data to back the usage of TIVADs in the upper arm, but this is not done in routine practice.[3] This is one other way of reducing the cost and increasing TIVAD usage in our patients.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Chandveetil J, Kattepur A, Pareekutty NM, Alapatt JJ, Mathiyazhakan AR, Kumbakara R, et al. Totally implantable venous access devices in cancer chemotherapy, retrospective analysis of 8421 catheter days in a tertiary cancer centre. Cancer Res Stat Treat 2021;4:449-55.  |
| 2. | Wu O, McCartney E, Heggie R, Germeni E, Paul J, Soulis E, et al. Venous access devices for the delivery of long-term chemotherapy: The CAVA three-arm RCT. Health Technol Assess 2021;25:1-126. |
| 3. | Wu S, Li W, Zhang Q, Li S, Wang L. Comparison of complications between peripheral arm ports and central chest ports: A meta-analysis. J Adv Nurs 2018;74:2484-96. |
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