Vascular Access for Chemotherapy

Vascular Access for Chemotherapy

Vascular access is a mode of accessing the bloodstream through central or peripheral blood vessels to draw blood or inject medications for chemotherapy. In this process, a venous access device (VAD) or catheter (a sterile plastic tube) is inserted into the blood vessel. This technique is helpful for cancer patients as it delivers medicines avoiding frequent needle pricks. 

 Indications for vascular access devices

Every patient doesn't require a vascular access device (VAD). Sometimes, the inconvenience of accessing and implanting a VAD may outweigh the benefits. The patient should ask a doctor if he requires a VAD if he experiences the following:

• Feeling anxious about needle insertion. 

• The veins are difficult to access or not accessible at all. 

• Discomfort due to vein assessment from foot or hand. 

• Undergoing continuous infusion chemotherapy for over an hour. 

• Anticipating several months of chemotherapy treatment. 

• Receiving intravenous chemotherapy that needs multiple needle pricks. 

• Treatment that requires the frequent drawing of blood samples. 

• The patient's treatment strategy involves chemotherapy agents that may cause pain in the vein when injected through the arm. 

• The doctor or physician recommends VAD insertion based on the patient's medical condition. 

Types of VADs

Although there are numerous types of VADs, the most common VADs used for cancer and taking blood samples are:

• Central venous catheters (CVC) are inserted into the large veins of the neck, arm, groin, or chest. These are used to deliver nutrients and medications for an extended period of time, weeks to months. Central venous access can be used for the following reasons. 

• To inject a combination of two or more medications at a time. 

• To get continuous infusion chemotherapy over 24 hours or more. 

• To get nutrients. 

• For frequent treatments.

• For home treatments.

• For long-term therapies. 

• To receive drugs that can damage skin and muscle tissues in case of leakage. 

Central venous catheters are classified into peripherally inserted central catheters, implanted ports, and tunneled catheters. 

• Peripherally inserted central catheters (PICC) are inserted at periphery sites like arm veins and extend towards the heart. They can be used to deliver chemotherapeutic agents. 

• Tunneled catheters- A tunneled catheter is inserted in the vein for long-term applications. It is generally inserted in the neck but can also be inserted in the groin, liver, chest, or back. Ultrasound guidance is required to insert the catheter and then tunnel it through the skin. A tunneled catheter has multiple lumens or channels for higher flow capacity. 

• Implanted ports- An implanted port is similar to a tunneled catheter but is left under the skin. These ports help to transport medicines. Some implanted ports have the same reservoirs that can also be filled. After filling, they release drugs into the bloodstream. Surgically implanted ports are inserted below the clavicle, and the catheters are threaded into the heart through a vein.  

 Risks associated with VADs

Complications or risks associated with VADs include:

• Infection- Catheters can insert bacteria into the blood that can lead to infections or sepsis. The risk of infection is decreased with the use of sterile techniques and proper care after insertion. This includes catheter cleanliness, washing hands before use, and use of clean dressings. 

• Pneumothorax- It can occur during the catheter insertion. Ultrasound can help to reduce the risk by determining the exact location of placement. 

• Bleeding- As catheters are inserted into the blood vessels, there's a high risk of bleeding during insertion. 

• Misplacement- These are likely to occur in cases where the patient's anatomy is hampered due to injuries. VADs can be inserted in arteries during insertion. A chest X-ray is taken out to minimise the risk of misplacement. 

• Thrombosis- VADs can form blood clots in the upper limb. 

The procedure of insertion of VADs

The procedure of a VAD insertion takes place in the following way:

Before the procedure

The patient is asked to undergo some tests to determine the presence or absence of clots in the blood. He needs to tell you about his medications, allergies or any other complications before the procedure. He should avoid the use of non-steroidal anti-inflammatory drugs or blood thinners as per the doctor's suggestion. The patient is given instructions on how to prepare for the procedure. This includes changes in the current medication schedule, what not to eat and drink before the procedure, post-operative care, etc.

During the procedure

The doctor performs certain tests to determine the most appropriate location for catheter insertion. After this, the operator wears sterile gloves and a gown to start the procedure.

A midline catheter and PICC can be inserted at the patient's side. These are inserted through a vein near the elbow and threaded through a large vein in the upper arm. In other catheter insertions, the doctor inserts an intravenous line into the vein of the arm or hand to provide sedatives intravenously. Therefore, the doctor makes a small incision at the site of insertion to place the VADs at the targeted position.

After the procedure

The doctor closes the incisions with stitches or surgical glue. An X-ray is performed to determine the correct position of the catheter and is removed before the patient is discharged.

How can CARE Hospitals help? 

At CARE Hospitals, we provide personalised treatment options based on the patient's preferences. Further, this procedure is performed by our best surgeons to provide effective results. We follow international treatment protocols to maintain the treatment standards.