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

Esther Green, Gail Macartney, Caroline Zwaal, Patricia Marchand, Lia Kutzscher, Pamela Savage, Linda Robb-Blenderman, Jocelyne Volpe, Lesley Collins, Melissa Brouwers, Mary Johnston, Hans Messersmith


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 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)?

Full Text:



Biffi, R., De, B.F., Orsi, F., Pozzi, S., Arnaldi, P., Goldhirsch, A., et al.

(2001). A randomized, prospective trial of central venous ports

connected to standard open-ended or Groshong catheters in adult

oncology patients. Cancer, 92(5), 1204-1212.

Bow, E.J., Kilpatrick, M.G., & Clinch, J.J. (1999). Totally

implantable venous access ports systems for patients receiving

chemotherapy for solid tissue malignancies: A randomized controlled

clinical trial examining the safety, efficacy, costs, and

impact on quality of life. J Clin Oncol, 17(4), 1267.

Brown-Smith, J.K., Stoner, M.H., & Barley, Z.A. (1990). Tunnelled

catheter thrombosis: Factors related to incidence. Oncol Nurs

Forum, 17(4), 543-549.

Camp-Sorrell, D. (2004). Access device guidelines:

Recommendations for nursing practice and education (2nd

ed.). Pittsburgh, PA: Oncology Nursing Society.

Canadian Intravenous Nurses Association. (1999). Intravenous therapy

guidelines (2nd ed.). Pembroke, ON: Pappin


Carde, P., Cosset-Delaigue, M.F., Laplanche, A., & Chareau, I.

(1989). Classical external indwelling central venous catheter versus

totally implanted venous access systems for chemotherapy

administration: A randomized trial in 100 patients with solid

tumours. Euro J Cancer Clin Oncol, 25(6), 939-944.

Centres for Disease Control and Prevention. (2002). Guidelines for the

prevention of intravascular catheter-related infections. MMWR

Recomm Rep, 51, 1-29, Report No.RR-10. Retrieved November

, from

Cortelezzi, A., Fracchiolla, N.S., Maisonneuve, P., Moia, M.,

Luchesini, C., Ranzi, M.L., et al. (2003). Central venous catheterrelated

complications in patients with haematological malignancies:

A retrospective analysis of risk factors and prophylactic measures.

Leuk Lymphoma, 44(9), 1495-1501.

Craft, P.S., May, J., Dorigo, A., Hoy, C., & Plant, A. (1996). Hickman

catheters: Left-sided insertion, male gender, and obesity are associated

with an increased risk of complications. Aust N Z J Med,

(1), 33-39.

De Cicco, M., Matovic, M., Balestreri, L., Panarello, G., Fantin, D.,

Morassut, S., et al. (1997). Central venous thrombosis: An early

and frequent complication in cancer patients bearing long-term

silastic catheter. A prospective study. Thromb Res, 86(2), 101-

Eastridge, B.J., & Lefor, A.T. (1995). Complications of indwelling

venous access devices in cancer patients. J Clin Oncol, 13(1),


Gleeson, N.C., Fiorica, J.V., Mark, J.E., Pinelli, D.M., Hoffman,

M.S., Roberts, W.S., et al. (1993). Externalized Groshong

catheters and Hickman ports for central venous access in gynecologic

oncology patients. Gynaecology Oncol, 51(3), 372-376.

Groeger, J.S., Lucas, A.B., Coit, D., LaQuaglia, M., Brown, A.E.,

Turnbull, A., et al. (1993). A prospective, randomized evaluation

of the effect of silver impregnated subcutaneous cuffs for preventing

tunnelled chronic venous access catheter infections in cancer

patients. Ann Surg, 218(2), 206-210.

Groeger, J.S., Lucas, A.B., Thaler, H.T., Friedlander-Klar, H., Brown,

A.E., Kiehn, T.E., et al. (1993). Infectious morbidity associated

with long-term use of venous access devices in patients with cancer.

Ann Intern Med, 119(12), 1168-1174.

Heeger, P.S., & Backstrom, J.T. (1986). Heparin flushes and thrombocytopenia.

Annals of Internal Medicine, 6, 105, 143.

Heit, J.A., O’Fallon, W.M., Petterson, T.M., Lohse, C.M., Silverstein,

M.D., Mohr, D.N., et al. (2002). Relative impact of risk factors for

deep vein thrombosis and pulmonary embolism: A populationbased

study. Arch Intern Med, 162(11), 1245-1248.

Howell, P.B., Walters, P.E., Donowitz, G.R., & Farr, B.M. (1995).

Risk factors for infection of adult patients with cancer who have

tunnelled central venous catheters. Cancer, 75(6), 1367-1375.

Intravenous Nurses Society. (2000). Infusion nursing: Standards of

practice. J Intraven Nurs, 23(Suppl. 6), S1-88.

Johansson, E., Bjorkholm, M., Bjorvell, H., Hast R., Takolander, R.,

Olofsson, P., et al. (2004). Totally implantable subcutaneous port

system versus central venous catheter placed before induction

chemotherapy in patients with acute leukaemia-a randomized

study. Support Care Cancer, 12(2), 99-105.

Kadidal, V.V., Mayo, D.J., & Horne, M.K. (1999). Heparin-induced

thrombocytopenia (HIT) due to heparin flushes: A report of three

cases. J Intern Med, 246(3), 325-329.

Kappers-Klunne, M.C., Degener, J.E., Stijnen, T., & Abels, J. (1989).

Complications from long-term indwelling central venous catheters

in hematologic patients with special reference to infection.

Cancer, .64(8), 1747-1752.

Kelly, C., Dumenko, L., McGregor, S.E., & McHutchion, M.E.

(1992). A change in flushing protocols of central venous catheters.

Oncol Nurs Forum, 19(4), 599-605.

Kelton, J.G. (2005). The pathophysiology of heparin-induced thrombocytopenia:

Biological basis for treatment. Chest, 127(2 Suppl.),


Keung, Y.K., Watkins, K., Chen, S.C., Groshen, S., Silberman, H., &

Douer, D. (1994). Comparative study of infectious complications

of different types of chronic central venous access devices.

Cancer, 73(11), 2832-2837.

Minassian, V.A., Sood, A.K., Lowe, P., Sorosky, J.I., Al-Jurf, A.S., &

Buller, R.E. (2000). Long-term central venous access in gynecologic

cancer patients. J Am Coll Surg, 191(4), 403-409.

Mueller, B.U., Skelton, J., Callender, D.P., Marshall, D., Gress, J.,

Longo, D., et al. (1992). A prospective randomized trial comparing

the infectious and non-infectious complications of an externalized

catheter versus a subcutaneously implanted device in cancer

patients. J Clin Oncol, 10(12), 1943-1948.

Nightingale, C.E., Norman, A., Cunningham, D., Young, J., Webb, A.,

& Filshie, J. (1997). A prospective analysis of 949 long-term central

venous access catheters for ambulatory chemotherapy in

patients with gastrointestinal malignancy. Euro J Cancer, 33(3),


Pasquale, M.D., Campbell, J.M., & Magnant, C.M. (1992). Groshong

versus Hickman catheters. Surg Gynaecology Obstet, 174(5),


Pegues, D., Axelrod, P., McClarren, C., Eisenberg, B.L., Hoffman,

J.P., Ottery, F.D., et al. (1992). Comparison of infections in

Hickman and implanted port catheters in adult solid tumour

patients. J Surg Oncol, 49(3), 156-162.

Pellowe, C.M., Pratt, R.J., Harper, P., Loveday, H.P., Robinson, N.,

Jones, S.R., et al. (2003). Evidence-based guidelines for preventing

healthcare-associated infections in primary and community

care in England. J Hosp Infect, 55(Suppl. 2), S2-127.

Pratt, R.J., Pellowe, C., Loveday, H.P., Robinson, N., Smith, G.W.,

Barrett, S., et al. (2001). The epic project: Developing national evidence-

based guidelines for preventing healthcare associated infections.

Phase I: Guidelines for preventing hospital-acquired infections.

Department of Health (England). J Hosp Infect, .47 Suppl.,


Raad, I., Davis, S., Becker, M., Hohn, D., Houston, D., Umphrey, J.,

et al. (1993). Low infection rate and long durability of nontunneled

silastic catheters. A safe and cost-effective alternative for

long-term venous access. Arch Intern Med, .153(15), 1791-

Registered Nurses Association of Ontario. (2004). Assessment and

device selection for vascular access. Retrieved November 2004,



Schmitt, B.P, & Adelman, B. (1993). Heparin-associated thrombocytopenia:

A critical review and pooled analysis. American Journal

of Medical Science, 305, 208.

Shelton, B.K. (2000). Evidence-based care for the neutropenic patient

with leukemia. Semin Oncol Nurs, 19(2), 133-141.

Sotir, M.J., Lewis, C., Bisher, E.W., Ray, S.M., Soucie, J.M., &

Blumberg, H.M. (1999). Epidemiology of device-associated infections

related to a long-term implantable vascular access device.

Infect Control Hosp Epidemiol, 20(3), 187-191.

Tesselaar, M.E., Ouwerkerk, J., Nooy, M.A., Rosendaal, F.R., &

Osanto, S. (2004). Risk factors for catheter-related thrombosis in

cancer patients. Euro J Cancer, 40(15), 2253-2259.

Verso, M., & Agnelli, G. (2003). Venous thromboembolism associated

with long-term use of central venous catheters in cancer

patients. J Clin Oncol, 21(19), 3665-3675.

Walder, B., Pittet, D., & Tramer, M.R. (2002). Prevention of bloodstream

infections with central venous catheters treated with antiinfective

agents depends on catheter type and insertion time: evidence

from a meta-analysis. Infect Control Hosp Epidemiol,

(12), 748-756.

Walshe, L.J., Malak, S.F., Eagan, J., & Sepkowitz, K.A. (2002).

Complication rates among cancer patients with peripherally inserted

central catheters. J Clin Oncol, 20(15), 3276-3281.

Warner, B.W., Haygood, M.M., Davies, S.L., & Hennies, G.A.

(1996). A randomized, prospective trial of standard Hickman compared

with Groshong central venous catheters in pediatric oncology

patients. J Am Coll Surg, 183(2), 140-144.


  • There are currently no refbacks.