Ivas, optimal use of venous access is fundamental in the therapeutic path of people with cancer

Finding the best solutions for the most effective administration of therapies and for the nutrition of cancer patients is essential for the correct care and management of people affected by cancer. Therefore, it is important to focus on the appropriate choice of vascular access as an integral part of the cancer patient’s therapeutic path, which also takes into account his or her needs. This is what emerges from the consensus document “The optimal use of peripheral insertion central catheters (Picc) in oncology and hematology”, issued by a group of experts from the main scientific societies in the sector, including representatives of the Italian Society of Vascular Access (Ivas) and the Italian Association of Advanced Skills Nursing (Ianac) with the unconditional contribution of Becton Dickinson. The document – reports a note – was created with the aim of outlining the indications, the selection process and the optimal use of PICs within the clinical-care process of the oncological and haematological patient and which sheds light on the need to re-examine the criteria for choosing the venous access devices currently present in Italian hospitals. “In recent years, thanks to new therapies and early diagnosis, it has been possible to increase the survival of the cancer patient. Now, the next and no less important goal is to offer this increase also a higher quality of life “, declares Carlo Carnaghi, Head of the Medical Oncology Operating Unit – Medical Oncology Unit, Humanitas Catanese Clinical Institute. “In the Italian oncological and haematological panorama, a rather fragmented picture still emerges today on the use of vascular accesses, despite the fact that in recent years there has been a rapid increase in Italy that has led our country to occupy second place at European level. – he continues – clinical practice seems to be characterized by the lack of a decision-making algorithm for the choice of the device to be implanted and by a gap between the indications reported in the guidelines and the degree of implementation of these in clinical practice, as well as by an interdisciplinary clinical inhomogeneity which could compromise the therapeutic outcome “. “The new recommendations specifically highlight how essential a proactive approach is also in the field of vascular accesses, to avoid important complications such as interruption of therapy, deterioration of blood vessels and the reduction of the risk of developing infections in particularly fragile patients such as those oncological “, concludes Carnaghi. The assistance to an oncological patient – the note recalls – necessarily involves the use of a vascular access, a small fixed catheter for the infusion of drugs (chemotherapy treatments), solutions and blood derivatives, the collection blood pressure and hemodynamic monitoring for central venous pressure measurement or for nutrition, substances that are often highly concentrated and given continuously. “The choice of the most durable and most procedural-free vascular access device in these patients , is the key to achieving the highest quality treatment with the mi minimum risk for patients and operators. The PIC and the new implant technologies (latest generation ultrasound scanners and visualization of the course of the catheter inside the patient without using X-ray) respond to this need “, declares Baudolino Mussa of the Department of General and Specialized Surgery and adjunct professor, Aou Città The advantages of the Piccs are many: safety and simplicity of the procedure for their positioning, which can be performed by adequately trained nursing staff and can be carried out directly at the patient’s bed. need for operating rooms, reducing intervention times and the need for post-implant repositioning, saving resources, costs and reducing the time required for the start of infusion therapy. Taken together, these characteristics make the PICs compatible with use both in hospital and out of hospital, including home, using a rigorous procedure sterile body and a portable instrumentation for the confirmation of the correct positioning of the tip by means of an ECG-guided test, using accurate methods of tip navigation and tip location, realized thanks to intracavitary electrocardiography (IC-ECG). “Another important component of the ‘current success of this procedure has been the direct involvement of the nursing staff which has also led to a greater degree of satisfaction on the part of patients in relation to the quality of care and the time dedicated “, says Fabio Conti, nursing coordinator for the Cardiology Area – Tor Vergata Polyclinic Foundation, Rome and president of Ianac. Who recalls how “in the consensus document the role of the Vascular access team (Vat) is highlighted in particular, which is able to make a reasoned evaluation to choose the best solution with the least impact on the patient and with the fewest possible complications, improving also the timeliness of treatment “. Finally, the Document underlines the importance of including the use and choice of the right vascular catheter, implantation and its subsequent management in the diagnostic-therapeutic pathways in oncology (Pdta), for the safety of care and healthcare professionals and for the quality of life of patients. “Although the widespread use of PICs in Italy generally witnesses an improvement in the criteria for choosing vascular access devices, the use of them remains lower than to what would be dictated by the actual clinical and care needs of patients and by the appropriateness criteria in many areas, including that onco-haematological. The need for stable vascular access should be an integral part of effective diagnostic and therapeutic management of patients throughout the disease course from the early stages. In fact, it is evident that these devices are fundamental to create the continuum of care in every phase of the disease and it is precisely for this reason that we need to focus on spreading the culture of venous access “, declares Baudolino Mussa.” This consensus document – he concludes – it goes precisely in this direction “.