‘Pinholes in my arms’: The vicious cycle of vascular access

Background: Vascular access devices (VADs) are essential for delivery of intravenous therapies. There are notable gaps in the literature regarding a focus on patient experience and meaning-making related to living with a VAD, specifically a central venous access device (CVAD). Aims: To explore how patients make sense of living with a CVAD. Methods: This study followed an interpretive phenomenological analysis (IPA) approach. Purposive sampling was used to identify 11 cancer patients who had a CVAD in situ. One-to-one semi-structured interviews were performed. Interviews were digitally recorded, transcribed and analysed by the lead author. Findings: Four superordinate themes were identified: the self under attack; being rescued/being robbed; protection of others/protection of self; bewilderment and dismay at lack of staff competence. Conclusion: Having a CVAD affects the psychological, social, and personal self and impacts on self-esteem and self-image. Despite this, CVADs are accepted by patients and are eventually ‘embodied’ by them.

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Central Venous Access Device Insertion by Qualified Vascular Access Specialists or Other Applicable Healthcare Clinicians

Journal of the Association for Vascular Access ◽

10.2309/j.java.2020.01.001 ◽

2020 ◽

Vol 25 (1) ◽

pp. 52-55

Author(s):

Timothy R. Spencer ◽

Amy Bardin-Spencer

Keyword(s):

Vascular Access ◽

Central Venous Access ◽

Venous Access ◽

Central Venous ◽

Central Venous Access Device ◽

Access Device ◽

Venous Access Device

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Type II Heparin-Induced Thrombocytopenia: Toward Developing a Strategy to Determine the Role of Routine Vascular Access Device Heparinization

Journal of the Association for Vascular Access ◽

10.2309/1552-8855-9.4.221 ◽

2004 ◽

Vol 9 (4) ◽

pp. 221-225

Author(s):

Kelli Rosenthal

Keyword(s):

Vascular Access ◽

Central Venous Access ◽

Venous Access ◽

Type Ii ◽

Heparin Induced Thrombocytopenia ◽

Access Device ◽

Clinical Literature ◽

Vascular Access Device ◽

Venous Access Device

Abstract Immunologic Heparin-induced Thrombocytopenia (HIT Type II) results from heparin exposure in any form, and can result in major intravascular thrombotic events, ischemia, and death. Type II HIT occurs in approximately 1 to 3% of patients receiving heparin and can occur at any dose or via any route of administration, making it a potentially serious complication of routine central venous access device (CVAD) maintenance with heparin flush locking techniques. A review of the clinical literature reveals largely anecdotal information implicating the role of heparin flush solutions in its development. Further study is needed to more specifically identify the likelihood of developing HIT from vascular access device related causes.

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Catheter lock solutions to prevent CVAD-related infection

British Journal of Nursing ◽

10.12968/bjon.2020.29.3.s25 ◽

2020 ◽

Vol 29 (3) ◽

pp. S25-S29 ◽

Cited By ~ 2

Author(s):

Janice A Gabriel

Keyword(s):

Central Venous Access ◽

Bloodstream Infections ◽

Venous Access ◽

Vascular Access Devices ◽

Global Challenge ◽

Lock Solution ◽

Number Of Patients ◽

Catheter Lock ◽

Venous Access Device

Demand for vascular access devices to meet the clinical needs of patients has increased dramatically in recent years, with a disproportionate increase in the numbers of individuals requiring a central venous access device (CVAD). With this increasing number of patients becoming recipients of CVADs globally each year, the associated incidence of catheter-related bloodstream infections (CRBSIs) is also increasing. In addition, there is strong evidence to demonstrate that antimicrobial resistance is a global challenge. There is a need to change the approach to CVAD management and get back to basics through a clearer understanding of how the incidence of CRBSIs can be reduced. This includes the role of biofilm and how its development can be inhibited through the use of an effective lock solution, and the avoidance of antibiotics.

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Vascular Access Devices: A Patient's Perspective

Journal of the Association for Vascular Access ◽

10.2309/1552-8855-10.2.81 ◽

2005 ◽

Vol 10 (2) ◽

pp. 81-84

Author(s):

Talulah Ruger

Keyword(s):

Vascular Access ◽

Central Venous Access ◽

Venous Access ◽

Chronic Illnesses ◽

Home Setting ◽

Vascular Access Devices ◽

Patient’S Perspective ◽

Parental Nutrition

Abstract Various vascular access devices are available and widely used in the hospital and home setting for the treatment of patients with acute and chronic illnesses. Many cancer patients, in particular, require Short- or long-term central venous access for the intravenous administration of chemotherapy, immunotherapy, blood products, antibiotics, total parental nutrition, and other medications. This author, a breast cancer survivor and a nurse, examines the benefits and drawbacks of venous access devices, the satisfaction and dissatisfaction with their use, and the effects these devices have on treatment and quality of life from a patient's perspective.

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Epidemiology of Device-Associated Infections Related to a Long-Term Implantable Vascular Access Device

Infection Control and Hospital Epidemiology ◽

10.1086/501609 ◽

1999 ◽

Vol 20 (03) ◽

pp. 187-191 ◽

Cited By ~ 42

Author(s):

Mark J. Sotir ◽

Curtis Lewis ◽

Edward W. Bisher ◽

Susan M. Ray ◽

J. Michael Soucie ◽

...

Keyword(s):

Hiv Infection ◽

Sickle Cell ◽

Vascular Access ◽

Venous Access ◽

Vascular Access Devices ◽

Access Device ◽

Underlying Illness ◽

Vascular Access Device ◽

The Difference ◽

Venous Access Device

AbstractObjective:To examine risk factors for, and determine the incidence of, device-associated infections among patients with an implantable vascular access device.Setting:Grady Health System, including a 1,000-bed, inner-city, public, teaching hospital and human immunodeficiency virus (HIV), oncology, and sickle cell clinics in Atlanta, Georgia.Patients:123 consecutive patients who received a PASPort implantable venous access device between January 1 and June 30, 1995.Design:Retrospective cohort study with follow-up ≥1 year following device implantation.Results:Underlying illnesses included HIV infection in 66 patients (median CD4 count, 24.4 cells/mm3), malignancy in 51, and sickle cell disease in 6. Mean age of patients was 43.7 years, 50% were male, and 74% were black. Thirty-one (25%) of 123 patients developed a primary or device-associated bloodstream infection (BSI), and 3 of the 31 patients experienced two separate episodes of infection. The overall rate of infection was 1.23 primary BSIs per 1,000 device days. Patients with cancer had a lower rate of infection than those with HIV infection, but the difference was not statistically significant (0.96 vs 1.50 BSIs/1,000 device days; relative risk, 0.58; 95% confidence interval, 0.27-1.26). Subgroup analysis of patients with different malignancies indicated that infection rates differed according to type of cancer, and there was a trend for heterogeneity across the different cancer strata (P=.06). Gram-positive pathogens accounted for 60% of the pathogens recovered. Six (19%) of 31 patients who developed an infection did so within the first 14 days after implantation. In 11 (32%) of the 34 BSIs, the port required removal; two patient deaths were attributed to device-associated bacteremias (0.072 deaths/ 1,000 device days).Conclusions:Approximately one fourth of patients who had a vascular access device implanted developed a primary BSI, but the overall infection rate (per 1,000 device days) was relatively low, even among those with HIV infection. Primary BSI rates in patients with vascular access devices appeared to differ according to the specific underlying illness.

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Risk factors determining central venous access device-associated deep vein thrombosis resolution in children: a retrospective study

European Journal of Pediatrics ◽

10.1007/s00431-021-03985-5 ◽

2021 ◽

Author(s):

Miguel García-Boyano ◽

José Manuel Caballero-Caballero ◽

Marta García Fernández de Villalta ◽

Mar Gutiérrez Alvariño ◽

María Jesús Blanco Bañares ◽

...

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Central Venous Access ◽

Venous Access ◽

Central Venous ◽

Central Venous Access Device ◽

Access Device ◽

Vein Thrombosis ◽

Venous Access Device ◽

Deep Vein

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Thromboembolism in Patients With Advanced Gastroesophageal Cancer Treated With Anthracycline, Platinum, and Fluoropyrimidine Combination Chemotherapy: A Report From the UK National Cancer Research Institute Upper Gastrointestinal Clinical Studies Group

Journal of Clinical Oncology ◽

10.1200/jco.2008.19.4274 ◽

2009 ◽

Vol 27 (23) ◽

pp. 3786-3793 ◽

Cited By ~ 122

Author(s):

Naureen Starling ◽

Sheela Rao ◽

David Cunningham ◽

Timothy Iveson ◽

Marianne Nicolson ◽

...

Keyword(s):

Combination Chemotherapy ◽

Treated Patient ◽

Controlled Trial ◽

Central Venous Access ◽

Locally Advanced ◽

Venous Access ◽

Gastroesophageal Cancer ◽

National Cancer Research Institute ◽

The Uk ◽

Venous Access Device

PurposeData concerning the prevalence of and outcomes related to thromboembolic events (TEs) in patients with advanced gastroesophageal cancer who are undergoing chemotherapy are limited.Patients and MethodsThis was a prospective, exploratory analysis of TEs in a randomized, controlled trial of 964 patients recruited between 2000 and 2005 and treated with epirubicin/platinum/fluoropyrimidine combination chemotherapy for advanced/locally advanced gastroesophageal cancer. Regimens were epirubicin (E), cisplatin (C), fluorouracil (F; ECF); E, C, capecitabine (X; ECX); E, F, oxaliplatin (O; EOF); and EOX. Continuously infused F was administered via a central venous access device (CVAD) with 1 mg of warfarin for thromboprophylaxis. The principal outcome was the incidence of TEs (venous and arterial) in the whole treated patient cohort, according to chemotherapy, associated with CVADs and TE-related prognoses.ResultsThe incidences of any, of venous, and of arterial TEs among 964 treated patients were 12.1% (95% CI, 10.7 to 14.3), 10.1% (95% CI, 8.3 to 12.3), and 2.2% (95% CI, 1.4 to 3.4) respectively. There were fewer TEs in the O compared with the cisplatin groups (EOF/EOX v ECF/ECX: 7.6% v 15.1%; P = .0003). C was identified as a risk factor for TE in multivariate analysis (hazard ratio [HR], 0.51; 95% CI, 0.34 to 0.76; P = .001). There was no difference in the incidence of TEs for the F group compared with the capecitabine groups. The incidence of CVAD-related thrombosis was 7.0% (ECF/EOF arms). Overall survival was worse for patients who experienced TEs versus no TEs (median survival, 7.4 v 10.5 months; HR, 0.8; 95% CI, 0.64 to 0.99; P = .043).ConclusionThis analysis has prospectively quantified the incidence/pattern of TEs among patients with advanced gastroesophageal cancer who were treated with four triplet regimens, has demonstrated a differential thrombogenic effect according to platinum use, and has noted a poorer outcome associated with TE during treatment. Chemotherapy-related TE should contribute to the risk/benefit assessment of treatment.

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