[A new system for permanent venous access, Cathlink 20: prospective clinical study. 95 cases]. / Un nouveau système pour l'accès veineux permanent, le Cathlink 20: étude clinique prospective. A propos de 95 cas.

A prospective clinical study of Cathlink, a new venous access system, was conducted in 95 cancer patients requiring long-term venous access (three months or more). Safety and efficacy of the device were also evaluated. This single-center study was done at the Bergonié Center, Regional Cancer Control Center, Bordeaux, France, from February 1994 to June 1998. Emergency cases were excluded. All patients gave their informed consent. The protocol was approved by the Bordeaux Ethics Committee. Cathlink low and standard profile systems were implanted in the prethoracic region. The catheter was introduced into a vein of the superior vena cava system in all 95 patients. Mean number of patient days was 11,295, and mean number of days per patient was 205,3636. Of the 493 accesses, 421 (79%) were successful at the first try. As compared with conventional implantable catheter devices, flow and location were better but access was more difficult, a shortcoming that will probably be improved by use of the Cathlink 20 standard profile device. The system was perceived as providing "natural" venous access by the nurses, who are now more used to using short catheters than Huber needles. Another important consideration is the enhanced safety provided by this system (no needle recoil after removal, and therefore no risk of infection, in particular due to viral agents).

[Patient-controlled analgesia in cancer pain: practical aspects]. / L'analgésie auto-contrôlée dans les douleurs du cancer: aspects pratiques.

Allowing a suffering patient with cancer to control his pain is a challenge that numerous medical teams intend to take up. Although the best treatment is the etiologic one, in many situations the symptomatic and adjuvant therapies are both indispensable. Among them, the patient controlled analgesia (PCA) is a concept referring to the management of the pain, but also to the administration of some analgesic drugs. Even with genuine advantages the limits of the PCA do exist and need to be well known. PCA is not limited to palliative treatment; it can be used in many circonstances during each evolutionary step of the cancer, temporarily or for longer periods, at the hospital and at home as well. All patients disposing of such an equiment could determine their own best level of analgesia, at the good time, depending upon the temporal variability of the pain and its previsibility or not. The availability and the pedagogic concern of the members of the team, the link between the patient and his family, the involvement of both the regular general practioner and the "algologic" team are essential to maintain the best effects of this method.