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Increasing the effectiveness of current chemotherapy strategies requires a higher dosage, the greater duration of treatment, multiple chemotherapy cycles, and strong adherence to recommended interval lengths between cycles. Anticancer drug administration (usually intravenously) may result in vessel wall irritation, phlebitis/phlebothrombosis, and tissue necrosis due to accidental drug extravasation. The small diameter of a peripheral vein, low blood flow velocity, easy bacterial invasion due to the proximity of the blood vessel to the contaminated skin frequently and quickly result in the aforementioned complications which render peripheral veins impossible to use as a venous access. A central venous access allows physicians to avoid most of these problems. However, its use may also lead to complications including infection, thrombosis and aeroembolism. Apart from that, multiple blood vessel punctures and a central vein catheterization for diagnostic tests, chemotherapy, maintenance treatment, and intravenous feeding have a negative effect on the quality of life. It should also be kept in mind that in pediatrics such an intrusive diagnostic method is done under general anesthesia, which is hazardous, by itself. Since a cancer treatment lasts for many months and even years, patients with traditional subclavian catheters face a significant decrease in quality of life, and experience difficulties in providing personal hygiene. This results in serious complications, the most dangerous of them being a catheterrelated infection and a catheter sepsis. They are often caused by a slight shift in a catheter position, which allows the pus from the puncture wound to enter the patient’s bloodstream along the outer wall of the catheter. Children may quite frequently put themselves in danger by removing an external catheter while receiving chemotherapy. It is especially dangerous if it occurs within the period of pancytopenia when the low blood count eliminates the option of a subclavian catheter, and thus an adjunctive therapy has to be given via a peripheral venous access. All the abovementioned issues may postpone the next treatment stage and ultimately have a negative effect on the whole treatment strategy and decrease its effectiveness.

Long-Term Venous Access in Oncology: Chemotherapy Strategies, Prevention and Treatment of Complications