Peripheral venous conditions are often poor in oncology patients undergoing long-term intravenous chemotherapy or in brain metastases with edema requiring frequent dehydrating drugs. Central venous access may be required when patients are expected to undergo long courses of chemotherapy or have difficulty with peripheral venipuncture, or when total parenteral nutrition is required due to malignant intestinal obstruction.
This article compares the techniques of indwelling needle, CVC, PICC, and infusion port with respect to the cost of the indwelling method, the cost of the maintenance method, and the complications, in the hope that they will be of benefit to the clinical work of oncology colleagues.
Intravenous indwelling needle
Cost: 60～80 RMB/time, maintenance about 20 RMB/day Time: 72～96 hours
Location: Superficial veins of the extremities (forearm preferred)
Method: Routine operation, done by nurse. The needle is inserted directly into the heparin cap during infusion. After daily infusion 50-100 U/mL of heparin saline 5-10 mL to seal the tube or special sealing solution pulsed positive pressure to seal the tube.
Advantages: less difficult to operate.
Disadvantages: short retention time, superficial veins are not suitable for long-term chemotherapy and nutrient infusion.
Complications: subcutaneous hematoma
Thrombosis-related risk: low, not serious
Infection-related risk: low
CVC
A central venous catheter is inserted into the superior and inferior vena cava through an internal jugular, subclavian, or femoral venous puncture and retained to provide convenient venous access.
Cost: $600-$800, maintenance about $20/day
Duration: about 2 to 4 weeks, longer time is prone to infection
Location: Right side of the neck, internal jugular vein, subclavian vein, femoral vein
Method: done by specially trained medical staff or anesthesiologist during surgery. The catheter is inserted directly from the internal jugular vein into the superior vena cava and secured in place. The needle is inserted directly into the heparin cap during the infusion. After daily infusion 0-10 U/mL heparin saline 10 mL is used to seal the tube.
Advantages: less difficult to operate.
Disadvantages: short retention time, high risk of dislodgement, inconvenient care, poor comfort.
Complications: pneumothorax, hemothorax, pneumothorax, hematoma, brachial plexus nerve, thoracic catheter injury, catheter ectasia, fractured tube, myocardial perforation, arrhythmia, arterial perforation.
Thrombosis-related risk: high
Infection-related risk: highest
PICC
Peripherally Inserted Central Catheter (PICC) is a catheter that is inserted by puncturing a peripheral vein with the head end in the superior vena cava or subclavian vein and is used to provide medium- to long-term (7 days to 1 year) intravenous fluid therapy to patients.
Cost: $2000 to $3000, maintenance about $70 to $80 per visit
Duration: several months, up to 1 year
Location: Elbow, vein, median elbow vein, cephalic vein
Method: done by specially trained medical staff. The central venous catheter is introduced into the superior vena cava by a guidewire, mostly using the Seldinger puncture method. The needle is inserted directly into the heparin cap during the infusion. After the infusion, the tube is sealed with 10 mL of saline pulsed with 0-10 U/mL heparin saline 20 mL. Infrequently, it is recommended to flush and change the tube once a week (20 mL NS flush and 3-5 mL heparin saline seal the tube)
Advantages: relatively inexpensive, relatively simple to operate and care, easy to administer, does not interfere with normal activities.
Disadvantages: weekly drug changes, prone to infection and thrombosis.
Complications: arrhythmias, arterial perforation, air embolism (rare), fractured tubes, myocardial perforation.
Thrombosis-related risk: high, 40% or more
Infection-related risk: high
Infusion port
An implantable venous access port (PORT) is a closed infusion device that is fully implanted in the body and includes a catheter portion with the tip in the superior vena cava and a subcutaneously embedded injection seat.
Cost: $6,000 to $8,000, maintenance about $200/month
Duration: Long-term use, suitable for more than 6 months of treatment.
Location: Subcutaneous anterior chest, subclavian vein
Method: Mostly done by anesthesiologists in the operating room under local anesthesia. The port of infusion is placed under the skin of the anterior chest, with the anterior end of the catheter in the superior vena cava and the posterior half subcutaneously in the chest wall. A butterfly needle is inserted into the infusion port to establish central venous infusion access. The infusion is followed by a 20 mL pulse of saline and 5 mL of 50 to 100 U/mL heparin saline to seal the tube. For infrequent use, it is recommended to flush every 4 weeks (20 mL physiological saline to flush and 3-5 mL heparin saline to seal the line).
Advantages: no increase in overall cost for long-term use, can be used for blood sample collection, aesthetic and convenient, can live and work normally, currently the best modality for patients treated with chemotherapy for malignancy including long-term parenteral nutrition.
Disadvantages: high cost of placement, trauma to both placement and removal.
Complications: catheter ectasia, catheter dislodging from DDS articulation and causing catheter entry into the superior vena cava or right atrium, arrhythmias, arterial perforation, air embolism, fractured tubes, myocardial perforation.
Thrombosis-related risk: low
Infection-related risk: low