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EVOLUTION OF INTRAVENOUS ACCESS IN ONCOLOGY 

Anesthesiologists play a significant role in securing different intravenous (IV) access for oncology patients. IV access is crucial for the administration of chemotherapy drugs, fluids, and other medications. Here’s an explanation of the various options available for IV access and how new options contribute to patient comfort:
  1. Peripheral Intravenous Catheter (PIVC): This is the most common and least invasive method of IV access. Anesthesiologists carefully select an appropriate peripheral vein in the patient’s arm or hand and insert a small plastic catheter into the vein. PIVC is relatively quick to insert and causes minimal discomfort. Newer options, such as smaller-gauge catheters and devices with improved insertion techniques, make the process more comfortable for patients.
  2. Midline Catheter: A midline catheter is a longer catheter that extends from the peripheral vein to a larger, more central vein. It provides a more stable and durable IV access option for patients requiring repeated or prolonged chemotherapy. Anesthesiologists can place midline catheters under ultrasound guidance, ensuring accurate positioning and minimizing discomfort for the patient.
  3. Central Venous Catheter (CVC): CVCs are inserted into large veins near the heart, such as the subclavian or jugular veins. These catheters offer long-term access and can accommodate higher flow rates for chemotherapy infusion. Anesthesiologists, often in collaboration with interventional radiologists, use imaging guidance to safely place CVCs. Newer CVC technologies, such as ultrasound-guided placement and tunneled catheters, enhance patient comfort and reduce the risk of complications.
  4. Peripherally Inserted Central Catheter (PICC): A PICC line is a long catheter that is inserted into a peripheral vein and advanced to a central vein, usually terminating near the superior vena cava. PICC lines offer a convenient and less invasive alternative to CVCs for patients requiring extended IV access. Anesthesiologists can place PICC lines under ultrasound guidance, minimizing patient discomfort and ensuring accurate tip positioning.
  5. Port-a-Cath: A Port-a-Cath, also known as an implanted port, is a small device that is placed beneath the skin. It consists of a reservoir connected to a catheter that is inserted into a central vein. Anesthesiologists, along with interventional radiologists or surgeons, can implant Port-a-Caths using local anesthesia. The device provides long-term, discreet IV access, and patients can receive chemotherapy and other medications by simply accessing the port with a special needle.
The advancements in IV access options have improved patient comfort during chemotherapy administration. Smaller-gauge catheters, improved insertion techniques, ultrasound guidance, and better imaging technologies have made the procedures more precise, less painful, and associated with fewer complications. These advancements also provide greater flexibility and convenience for patients undergoing prolonged or repeated chemotherapy treatments.
Anesthesiologists work closely with the oncology team to determine the most appropriate IV access option for each patient based on their treatment needs, expected duration of therapy, and individual circumstances. The goal is to ensure effective and comfortable IV access while minimizing the potential for complications and maximizing patient comfort during their cancer treatment journey.

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Author

  • Renny

    Dr Renny , is a well-regarded anesthesiologist with years of experience in a broad variety of surgical specialties. He has built a sterling reputation as an anesthesiologist over more than a decade of service to people of all ages and walks of life. Experience: 1. Consultant, VPS Lakeshore Hospital Kochi 08/2015- Present. 2. Specialist, PVS Memorial Hospital Kochi 07/2013-07/2014. 3. Resident, Sunrise Hospital Kochi 08/2010-07/2013.   Achievements in Anesthesia 100+ liver transplants, 100+ kidney transplants, 1 intestinal transplant, 1 combined kidney-pancreas transplant, 2 hand transplants. 500+ adductor canal blocks, 400+ erector spinae blocks in addition to brachial plexus blocks, lower limb blocks 300+ joint replacements, polytrauma management, spine surgeries including scoliosis correction, brachial plexus surgeries, and head injury. Awake fiber optic intubations, and microlaryngeal surgeries. Knee replacement for alkaptonuria, liver transplant for hyperoxaluria, Wilson’s disease, hepatopulmobary syndrome (SpO270%). Anesthesia to live CME surgeries- Scoliosis by Dr Krishna Kumar, Urology surgeries by Dr George P Abraham, Laparoscopic surgeries by Dr Padmakumar. DNB co-ordinator for Formative Assessment Test 2018, 2020, 2021 DNB guide since 2018.

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