Journal: Annals of internal medicine
This publication highlights the critical importance of safe and reliable venous access in cancer care. Vascular access devices (VADs) are essential for delivering chemotherapy and supportive treatments while reducing serious risks such as bloodstream infections and venous thromboembolism.
An international multidisciplinary panel used the RAND/UCLA Appropriateness Method to develop evidence-based recommendations for VAD selection, insertion, and management in cancer patients. These recommendations were based on a comprehensive literature review and evaluation of 1,422 clinical scenarios.
The appropriateness of VAD types varies according to:
- Cancer type
- Treatment urgency
- Expected duration
Key recommendations include:
- For acute hematologic malignancies needing urgent chemotherapy: double-lumen PICCs or tunneled central venous catheters are preferred.
- For solid tumors: single-lumen tunneled CVCs or implanted ports are recommended across treatment intensities.
- Emphasis on collaboration: working with nephrologists to preserve veins in patients with advanced kidney disease.
The resulting Michigan Appropriateness Guide (MAGIC-ONC) aims to improve clinical outcomes, reduce complications, and promote quality and safety in vascular access for cancer patients.