Traitement curatif de la maladie thromboembolique veineuse et prise en charge des thromboses veineuses sur cathéter chez les patients atteints de cancer

[Central venous access for cancer chemotherapy]

The tip of a long term central venous access should be located at the junction of the superior vena cava with the right atrium in order to reduce the incidence of dysfunction and venous thromboses. Picc-lines have their place for treatments of less than 6 months with obvious advantages in terms of discretion and comfort. Long-term sequential chemotherapy is an indisputable indication of an implantable port, while long-term parenteral nutrition is an indication of a tunneled cuffed catheter. In case of mediastinal compression, the risk-benefit ratio favors femoral access. Catheter related venous thrombosis or infection do not necessarily require the withdrawal of the device. A device that is no longer used should be removed when the likelihood of recurrence of the disease is low or too far.

[Long-term intravenous devices, continuity of care from the specialist doctor to the nurse]

Long-term intravenous devices have become an essential tool in the treatment of patients requiring the administration of medication over more than one month. The choice of device must be established through consultation between the nursing team and the patient. Several types of complications can be observed immediately after the insertion of the device and during treatment. Protocols in the community and at hospital are therefore necessary in order that doctors, nurses, specialists and experts work together. Clinical and translational research should enable the incidence of certain complications, notably infections and thrombosis, to be further reduced.