ONLINE special article managing central venous access devices in cancer patients: A practice guideline

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: To prevent catheter-related intraluminal thrombosis and local or 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? In patients who require systemic therapy for cancer, what indicators impact the decision to insert a central venous access device (CVAD)?