Venous Access Devices: Clinical Rounds.

Nursing management of venous access devices (VADs) requires knowledge of current evidence, as well as knowledge of when evidence is limited. Do you know which practices we do based on evidence and those that we do based on institutional history or preference? This article will present complex VAD infection and occlusion complications and some of the controversies associated with them. Important strategies for identifying these complications, troubleshooting, and evaluating the evidence related to lack of blood return, malposition, infection, access and maintenance protocols, and scope of practice issues are presented.

Central venous catheter care for the patient with cancer: American Society of Clinical Oncology clinical practice guideline.

PURPOSE: To develop an evidence-based guideline on central venous catheter (CVC) care for patients with cancer that addresses catheter type, insertion site, and placement as well as prophylaxis and management of both catheter-related infection and thrombosis. METHODS: A systematic search of MEDLINE and the Cochrane Library (1980 to July 2012) identified relevant articles published in English. RESULTS: The overall quality of the randomized controlled trial evidence was rated as good. There is consistency among meta-analyses and guidelines compiled by other groups as well. RECOMMENDATIONS: There is insufficient evidence to recommend one CVC type or insertion site; femoral catheterization should be avoided. CVC should be placed by well-trained providers, and the use of a CVC clinical care bundle is recommended. The use of antimicrobial/antiseptic-impregnated and/or heparin-impregnated CVCs is recommended to decrease the risk of catheter-related infections for short-term CVCs, particularly in high-risk groups; more research is needed. The prophylactic use of systemic antibiotics is not recommended before insertion. Data are not sufficient to recommend for or against routine use of antibiotic flush/lock therapy; more research is needed. Before starting antibiotic therapy, cultures should be obtained. Some life-threatening infections require immediate catheter removal, but most can be treated with antimicrobial therapy while the CVC remains in place. Routine flushing with saline is recommended. Prophylactic use of warfarin or low-molecular weight heparin is not recommended, although a tissue plasminogen activator (t-PA) is recommended to restore patency to occluded catheters. CVC removal is recommended when the catheter is no longer needed or if there is a radiologically confirmed thrombosis that worsens despite anticoagulation therapy.

State of the science of oncology vascular access devices.

OBJECTIVE: To present an overview of long-term vascular access devices (VADs), current maintenance care, controversies of care, and the need for VAD research. DATA SOURCES: Current research and published literature. CONCLUSION: Over the last four decades, VADs have become a standard part of caring for patients in all clinical settings. Despite the common use of VADs, current standardized procedures for maintenance care and managing complications are not available. IMPLICATIONS FOR NURSING PRACTICE: The key to establishing evidence-based practice is to create a network of researchers, clinicians, and policy makers in a consortium to secure funding and implement multisite research. Only through research will traditional practice be challenged.

Cancer and its treatment effect on young breast cancer survivors.

OBJECTIVES: To discuss issues of fertility after chemotherapy and the young breast cancer survivor. DATA SOURCES: Research articles and literature reviews. CONCLUSION: Reproductive concerns are important to young breast cancer patients. Discussing these concerns and exploring options are crucial before beginning cancer treatment. IMPLICATIONS FOR NURSING PRACTICE: Reproductive effects from treatment can have a significant impact on the long-term health and quality of life of young women with breast cancer. Oncology nurses are a vital source to discuss concerns and explore options with the patient.

Cardiovascular late effects.

Cancer survivors who have received cardiotoxic chemotherapy or mediastinal radiation have an increased risk of developing cardiovascular late effects. Cardiac functioning should be evaluated during follow-up exams based on the patient's risk factors, cardiac symptoms, and type of cancer treatment received. Signs and symptoms indicative of cardiovascular late effects include dyspnea, fatigue, tachycardia, nonproductive cough, neck vein distention, coarse breath sounds, and pedal edema.

Clinical dilemmas: vascular access devices.

OBJECTIVES: To present an overview of clinical dilemmas regarding maintenance care and managing complications of vascular access devices (VADs). DATA SOURCES: Current research and published literature. CONCLUSION: The use of VADs has increased over the past three decades because they have proven to be an effective and convenient method of accessing the venous system. The difficulty of maintaining VADs during the course of treatment however, continues to be a challenge resulting in practice dilemmas. IMPLICATIONS FOR NURSING PRACTICE: Although VADs have been in use for more than 30 years, no universal standard of maintenance care exists. Research is still needed to establish evidence-based practice regarding the care and maintenance of VADs.

Antiangiogenesis: the fifth cancer treatment modality?

PURPOSE/OBJECTIVES: To describe the biologic process of angiogenesis and the potential role of antiangiogenesis therapy in cancer treatment. DATA SOURCES: Published articles, conference proceedings, and computerized databases. DATA SYNTHESIS: Angiogenesis is the development of blood vessels. Antiangiogenic agents prevent the development of blood vessels, therefore preventing one mode of cancer metastasis. Clinical trials must be conducted to ascertain the most powerful antiangiogenic therapies. Trials combine chemotherapy, biotherapy, and radiotherapy with antiangiogenic therapy. CONCLUSIONS: Information from animal studies has revealed that antiangiogenesis is a viable option in treating cancer and preventing metastasis. Although human studies are rare, preliminary results are promising, especially when antiangiogenesis is used in combination with current cancer treatment modalities. IMPLICATIONS FOR NURSING: Nurses are in a unique position to teach patients about new treatments for cancer. Nurses must be knowledgeable about angiogenesis and the availability of potential antiangiogenesis agents. Nurses will be vital in collecting data in clinical trials, considering the subjective data that will be obtained.

Maintenance of venous access devices in patients with neutropenia.

Neutropenia is a common complication in patients with cancer who are undergoing chemotherapy. Because of treatment frequency, potential chemotherapy damage to peripheral veins and tissues, and pain from multiple venipunctures, venous access devices (VADs) often are used in the oncology setting. Although VADs have been used for 30 years, no sufficient scientific data exist to support the best care and maintenance strategies for their use in patients with neutropenia. Understanding the etiology and pathogenesis of VAD-related infections (VAD-RI) and the proper steps to prevent or quickly treat it can decrease the likelihood that patients with neutropenia will have a fatal response. This article describes the differences between VADs, the most common sources of VAD-RI, and the treatment of such infections and suggests nursing interventions to help prevent VAD-RI.