ONLINE Special Article Managing central venous access devices in cancer patients: A practice guideline

Abstract

In cancer care, central venous access devices (CVADs) are used to safely manage patients undergoing long-term systemic treatment. CVADs are also used to ensure the safe delivery of other agents, biotherapy and supportive therapies. Nursing practice is often driven by policies and procedures that may or may not be evidence-based. Prevention of catheter-related intraluminal thrombosis is essential for quality care. Therefore, there is a need for evidence-based standardized protocols across the system. To address the issue, our group conducted a systematic review of the existing literature, which addressed the following questions:1. To prevent catheter-related intraluminal thrombosis and localor systemic catheter-related infection, minimize the need to replace devices, and enhance quality of life of adults with cancer:- Should CVADs be locked with heparin or saline?- What volume and strength of solution should be used to lock CVADs?- How frequently should CVADs be locked or flushed?- What type of catheter should be used?2. In patients who require systemic therapy for cancer, what indicators impact the decision to insert a central venous access device?The MEDLINE, CINAHL, EMBASE and Cochrane Library databases were systematically searched for relevant guidelines and studies. Evidence was selected and reviewed by the Central Venous Access Devices Guideline Working Panel of Cancer Care Ontario's Program in Evidence-based Care (PEBC). Recommendations were formed through a review of the evidence, including best practice guidelines and, where the evidence was lacking, the expert opinion and the consensus process was used. External review of there commendations by Ontario practitioners was obtained through a mailed survey. The recommendations were then revised by the CVAD Working Panel. Final approval of the systematic review and recommendations was obtained from the PEBC Report Approval Panel. The systematic review revealed a lack of standardized protocols for the choice and management of CVADs. It is hoped this paper will influence standardized protocol across institutions in order to: increase patient confidence in nursing care as patients move from institution to institution, simplify nursing education, and develop research that can lead to evidence to inform decision-making on the issues identified.