Information
There are several risks and complications related to central venous access devices (CVADs). Infections, thrombosis, phlebitis, haematoma and displaced devices are the commonest problems encountered.
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. Suspected clots need further investigation at hospital and treatment with therapeutic LMWH if confirmed.
Mechanical phlebitis most commonly occurs with PICC lines up to 72 hours post insertions.
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. Infective phlebitis can also occur and may need topical treatments or oral antibiotics. Discussion with oncology is advised.
Antibiotics are indicated – route of administration will depend on clinical situation, evidence of sepsis and neutrophil count. Luminal infections untreated can be life threatening and urgent referral to hospital is necessary.
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 6 weeks of treatment should be encouraged to monitor symptoms and call Cancer Treatment Helpline (CTH) on 08009177711 if any treatment related concerns. Please note the CTH is a call operator service provided by NHS 24 who then refer on to acute care specialist. They are not able to give specialist advice. Note if a patient has presented to primary care for assessment the patient should not be advised to call the CTH to pass on this information or seek further advice. The primary care clinician should call the Acute Oncology teamat the Edinburgh Cancer Centre to discuss if appropriate.
Link to Acute Oncology Initial Management Guidelines:
UKONS | Acute Oncology Initial Management Guidelines (sundownsolutions.co.uk)
