CHRONIC VENOUS ACCESS IN PATIENTS WITH CANCER - SELECTIVE USE OF THE SAPHENOUS-VEIN

Background. Dependable chronic venous access is an important aspect of supportive care for patients requiring chemotherapy or other long-ter m therapy because it enables such patients to be treated on an outpati ent basis. Methods. The authors studied 56 patients with cancer requir ing chronic venous access who had an infusion catheter placed into the inferior vena cava (IVC) through open saphenous venotomy, most common ly because superior vena cava (SVC) occlusion, severe chest wall infec tion, or chest wall malignancy precluded standard subclavian or jugula r cannulation. Results. The 56 catheters were in place for 12-550 days . The overall complication rate was 0.30 complications per 100 cathete r-days. Thirty-six patients (64%) had no complications. Among the rema ining 20 patients, 8 (14.3%) had a local infection, 2 (3.6%) had syste mic bacteremia, and 10 had lower extremity edema, including 9 patients (16.1%) in whom the IVC was thrombosed. Twelve of the 20 complication s were treated successfully without catheter removal. Thus, in 86% (48 of 56) of patients, the catheter was effective for as long as infusio n therapy was required. Conclusion. Venous cannulation through the sap henous vein is a useful method of achieving and maintaining chronic ve nous access in patients in whom the subclavian or jugular veins are un available.