Venous access devices for the delivery of long-term chemotherapy: the CAVA three-arm RCT.

Background: Venous access devices are used for patients receiving long-term chemotherapy. These include centrally inserted tunnelled catheters or Hickman-type devices (Hickman), peripherally inserted central catheters (PICCs) and centrally inserted totally implantable venous access devices (PORTs).

Objectives: To evaluate the clinical effectiveness, safety, cost-effectiveness and acceptability of these devices for the central delivery of chemotherapy.

Central venous access devices for the delivery of systemic anticancer therapy (CAVA): a randomised controlled trial.

Background: Hickman-type tunnelled catheters (Hickman), peripherally inserted central catheters (PICCs), and totally implanted ports (PORTs) are used to deliver systemic anticancer treatment (SACT) via a central vein. We aimed to compare complication rates and costs of the three devices to establish acceptability, clinical effectiveness, and cost-effectiveness of the devices for patients receiving SACT.

Methods: We did an open-label, multicentre, randomised controlled trial (Cancer and Venous Access [CAVA]) of three central venous access devices: PICCs versus Hickman (non-inferiority; 10% margin); PORTs versus Hickman (superiority; 15% margin); and PORTs versus PICCs (superiority; 15% margin).

Retained port connectors after central venous port removal.

We report three cases where the connector/sleeve, which helps fix the flexible catheter section to a port injection chamber, was inadvertently left in scar tissue during port removal. Concerned patients presented months later with a palpable subcutaneous nodule, near the port site. The nodules were variably imaged with plain X-rays, mammography or ultrasound with the diagnosis correctly made by a surgeon familiar with devices.