Information
There are several risks and complications related to central venous access devices (CVADs). A patient presenting with any of the following should be referred via Acute Oncology team
- Infections – Infective phlebitis can occur and may need topical treatments or oral antibiotics. Discussion with oncology is advised. Most common symptoms are pain, erythema, superficial skin infections around the insertion site or luminal infections which often present with pyrexia after flushing the catheter.
- Thrombosis – CVAD’s increase the risk of clot formation in blood vessels. Symptoms include oedema, inability to aspirate the line and pain in the arm, shoulder and chest.
- Phlebitis – Mechanical phlebitis most commonly occurs with PICC lines up to 72 hours post insertions.
- Bleeding from insertion site,
- Displacement of PICC line can occur, if there is any movement in PICC line external measurements
- CVAD not bleeding
M.A., K.E. & J.W. 12-02-26
Who to refer:
Patients with a cancer diagnosis you suspect to have a complication related to their CVAD. Refer if:
Unable to aspirate blood from the line please refer the patient as this may indicate fibrin sheath/thrombosis formation or migration of the line.
Haematoma has formed around the insertion site as may be due to uncontrolled bleeding or thrombocytopenia.
Catheter migration or damage happens infrequently but if it does occur please refer as the line may need replacing
We may be able to give advice over the phone or the patient may need to attend hospital for further investigation. Any patient with suspected line related sepsis must be referred urgently to their nearest hospital.
Who not to refer:
If in doubt please do not hesitate to call the on call oncology team. If sepsis is suspected you may be advised to admit the patient to their nearest hospital.
How to refer:
Contact the Acute Oncology team at the Edinburgh Cancer Centre on 07798774842 or 0131 537 1000 and ask to speak to Acute Oncology team for oncology.
All patients on or within six weeks of treatment should be encouraged to monitor symptoms and call The Cancer Treatment Helpline (CTH; 08009177711) with any treatment-related concerns. Please note, the CTH is a call operator service provided by NHS 24, who then refer on to an acute care specialist. They cannot give specialist advice.
If the patient has been assessed by a healthcare practitioner in Primary Care, and Oncology advice/input is felt to be required, the Primary Care clinician should call the Acute Oncology team at the Edinburgh Cancer Centre (based in the WGH) and discuss directly. The Acute Oncology team can be contacted during working hours (Mon-Fri 9-5) on 07798774842; If out of hours, please discuss with the Oncology Registrar On-Call via NHS Lothian Switchboard (0131 537 1000).
If the primary care clinician requires any further guidance on the suitability of referral to Acute Oncology, they can consult Pg 10 of the The UKONS Oncology/Haematology 24 Hour Triage Toolkit.
Note if a patient has presented to primary care for assessment, the patient should NOT be advised to call the CTH themselves to pass on this information or seek further advice.
Link to Acute Oncology Initial Management Guidelines:
UKONS | Acute Oncology Initial Management Guidelines (sundownsolutions.co.uk)
