Vascular Access

Prolonged and safe venous access remains a critical aspect of care of cancer patients. Central venous access devices (CVAD) in the form of tunneled catheters, peripherally inserted central catheters (PICC), or totally implantable venous access devices (TIVAD) are preferred in the majority of these patients. The choice depending on the nature of chemotherapeutic drugs and frequency of administration, volume, concentration of infusate, requirement for frequent transfusion of blood and blood products, age and choice of the patient. While they are largely safe in centers with experienced clinicians and trained nurse’s familiar with techniques of catheter insertion, use, and maintenance infrequently, their use is fraught with early or late complications some of which need urgent attention. In this chapter, we try to give an overview of the topic: “venous access in oncology,” with a thrust on central venous access. We will cover the subtopics; classification of CVAD, choice of the device for an individual patient, insertion technique, and common situations requiring troubleshooting, catheter maintenance, and recognition and management of long-term complications.