https://www.amjmed.com/article/0002-9343(82)90774-4/pdf

Totally implanted system for intravenous chemotherapy in patients with cancer

One hundred and six long-term right atrial (Hickman) catheters have been used to establish permanent venous access in 99 patients undergoing prolonged chemotherapy for leukemia and other malignancies at the University of Maryland/Baltimore Cancer Research Center over the 30-month period from November 1978 to May 1981. A uniform technique for insertion, using cannulation of the external or internal jugular vein and atraumatic dissection of the subcutaneous tunnel, has resulted in no episodes of hemorrhage or tunnel infection in the last 55 placements in these high-risk granulocytopenic, thrombocytopenic patients. Twelve catheters have now been in place for over one year, and two catheters have been in place for over two years without apparent ill effects. A low catheter related infection rate is attributed to meticulous adherence to catheter care guidelines, supervised by a single trained and interested nurse. Cancer 52:185-192, 1983.

https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/1097-0142%2819830701%2952%3A1%3C185%3A%3AAID-CNCR2820520134%3E3.0.CO%3B2-R

Prolonged venous access for chemotherapy by means of the hickman catheter

We evaluated a totally implanted system consisting of a subcutaneous injection port connected to a silicone elastomer central venous catheter for vascular access, including blood drawing, in 35 patients with cancer. All patients lacked peripheral venous access sites and were undergoing aggressive chemotherapy programs. The cumulative duration of successful access exceeded 2,900 days (for individual patients: range, five to 203 days; median, 61 days). In no instance were infusions or injections unsuccessful. Blood-sampling attempts were successful 90% of the time. The system did not require flushing between uses, being filled with heparinized saline after each entry. There were no instances of irreversible catheter occlusion or shear and no system-related infections. Thus, this device appears to have advantages over other central venous catheters in terms of patient acceptance and lack of maintenance between uses. ( JAMA 1984;251:2538-2541)

A Totally Implanted Injection Port System for Blood Sampling and Chemotherapy Administration

https://www.gastrojournal.org/article/S0016-5085(77)80270-9/pdf

Parenteral Nutrition at Home for 5 Years Via Arteriovenous Fistulae: Supplemental Intravenous Feedings for a Patient with Severe Short Bowel Syndrome

In 100 consecutive patients with various malignancies, 142 operations were performed to establish an arteriovenous fistula giving vascular access for chemotherapy. The fistula of choice was always an end-to-side fistula between the cephalic vein and the radial artery (radiocephalic fistula). A fistula of this type was established in 88 operations on 76 patients and functioned well in 64% of this group. In 29 patients in whom this fistula failed or was not feasible, an elbow fistula was performed in 32 operations and functioning well in 59%. In 13 patients whose arms offered no alternative possibility, 15 long saphenous vein (LSV) autografts were implanted in the inguinal region. A radiocephalic fistula was successfully performed in 77% of the patients who had received preoperative chemotherapy during less than 4 weeks, versus 26% of those who had received preoperative chemotherapy during a longer period. The radiocephalic fistula is the fistula of choice to gain vascular access for chemotherapy. It has proved necessary to perform this operation before chemotherapy is started. When this type of fistula is not feasible, alternatives are an elbow fistula or an (LSV) autograft in the inguinal region.

McCredie Kb

Papers

Vascular access by means of surgically created arteriovenous fistulas in the chemotherapy of acute leukemia: a preliminary report.