Vascular access device choice for chemotherapy
Abstract:
Objective: Ensuring reliable central venous access with the least complications is vital for cancer patients receiving chemotherapy. A systematic review and network meta-analysis was conducted to compare the safety, quality of life (QoL) and cost effectiveness of different types of central venous access device (CVAD) for patients receiving chemotherapy.
Methods: PubMed, EMBASE and Cochrane were searched from inception to 20th August 2021 for randomized controlled trials comparing the various CVADs [non-tunnelled central venous catheter (non-tunnelled catheter), peripherally inserted central venous catheter (PICC), totally implantable ports (PORT), and tunnelled catheter].
Results: A total of 11 eligible RCTs comprising 2585 patients were identified. PORT was associated with lower odds of overall complications, device removal due to complications, thrombotic and mechanical complications compared to PICC [(Odds Ratio (OR) 0.54, 95% CI 0.43 – 0.69), (OR 0.49, 95% CI 0.26 – 0.93), (OR 0.37, 95% CI 0.23 – 0.62) and (OR 0.35, 95% CI 0.13 – 0.95) respectively]. Tunnelled catheter was associated with higher odds of overall complication rate, device removal due to complications and infective complications compared to PORT [(OR 1.68, 95% CI 1.30 – 2.17), (OR 2.52, 95% CI 1.34 – 4.73), (OR 2.11, 95% CI 1.14 – 3.90) respectively]. Ranking probability based on SUCRA values indicated that PORT had the lowest probability of overall complications, removal due to complications, and thrombotic complications.
Conclusion: PORT is superior in terms of complications, QoL compared to other CVADs without compromising on cost effectiveness and should be considered the standard of care in patients receiving chemotherapy.
Reference:
Yeow M, Soh S, Yap R, Tay D, Low YF, Ning Goh SS, Yeo CS, Lo ZJ. A systematic review and network meta-analysis of randomized controlled trials on choice of central venous access device for delivery of chemotherapy. J Vasc Surg Venous Lymphat Disord. 2022 Mar 30:S2213-333X(22)00171-8. doi: 10.1016/j.jvsv.2022.03.007. Epub ahead of print. PMID: 35367407.