Unfortunately, I think some of the choice is also due to local experience. When PICCs were introduced into our hospital, before we started using statlocks, several of the patients had "inadvertent discontinuations" of these lines. So our med oncs didn't like them and thought they were "flimsy." (Don't kill the messenger.) Also, if surgeons place ports in locations that are difficult to access, or there are complications such as tipped ports, this might lead the med oncs to choose other types of lines. We have a very good IR dept here--port pockets and incisions are small, located in good places for access. Some of the surgeons placements are a bit dicier--buried deeper in breast tissue, etc.
I have brought up again to our CNO that we need a PICC/CVC nurse to lead the charge for appropriate selection of devices as well as education of all staff, incl physicians, about CVCs. I don't know about you, but FTEs are VERY hard to come by these days. Donna Fritz -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Mats Strömberg Sent: Friday, December 23, 2005 6:59 AM To: Venous Subject: SV: Spam: Breast cancer VAD choice Donna, We give a lot of FEC (5FU + epirubicin + cytoxan) and taxanes for our breast cancer patients. We have always used almost exclusively ports, but are now using more and more PICCs. Nearly no Hickmans. We also wish to get a more individualized VAD choice process, with consideration taken to patient preferences. Mats Den 05-12-23 00.04, skrev "Fritz, Donna" <[EMAIL PROTECTED]>: > I'm addressing bullet point #3. I think you will have to look at what chemo > is giving in your area for breast ca treatment. We're doing adriamycin + > cytoxan, followed by a taxane, usually taxol. It's usually given on an every > 3 week basis for several months. It seems an ideal circumstance for a port. > > I think your line has to match the type of therapy patients will receive. For > colon patients receiving continuous 5FU, an externalized tunneled cath seems > more suited. > > Unfortunately, our physicians make the choice without presenting options to > the patient, but this is kind of how they decide. No evidence basis here. > > Donna Fritz, RN, MN, OCN > Oncology CNS > > > > -----Original Message----- > From: [EMAIL PROTECTED] > [mailto:[EMAIL PROTECTED] Behalf Of Mats Strömberg > Sent: Thursday, December 22, 2005 11:32 AM > To: Venous > Subject: Spam: Breast cancer VAD choice > > > Dear listers, > > I am going to write about half a page on vascular access device choice for > breast cancer patients. It is part of a larger set of guidelines for breast > cancer. > > The things I would like to address are: > - The importance of early assessment > - The advantages of central venous access devices (like better hemodilution > preserving the veins, lower risk for extravasation) > - The individual advantages of implanted ports, PICCs and Hickman lines > - When to opt for peripheral access > > Is this the things that I should address? > > I need to show the evidence base for everything. What is the evidence for > these things? What is the important litterature to use as references? > > Thanks in advance > Mats in Stockholm > > ---- > Mats Strömberg, RN, Research nurse > Dept. of Oncology > Karolinska University Hospital, Solna > SE-171 76 Stockholm > > E-mail: [EMAIL PROTECTED] > Phone int: +46 8 517 76376 > Mobile phone int: +46 70 471 6661 > > > > > > ***************************************************************************** > This communication is for the use of the intended recipient only. It may > contain information that is privileged and confidential. If you are not the > intended recipient of this communication, any disclosure, copying, further > distribution or use thereof is prohibited. If you have received this > communication in error, please advise me by return e-mail or by telephone and > delete/destroy > it. ************************************************************************** > *** ***************************************************************************** This communication is for the use of the intended recipient only. It may contain information that is privileged and confidential. If you are not the intended recipient of this communication, any disclosure, copying, further distribution or use thereof is prohibited. If you have received this communication in error, please advise me by return e-mail or by telephone and delete/destroy it. *****************************************************************************
