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PICC or Port? What is the best access for cancer patients

As we know, this decision is never simple. What is known is that there is an urgent need to create an access, to guarantee the beginning of treatment as soon as possible, and that the clinical conditions of the patients must be evaluated taking into account the estimated duration of treatment and protocol regime to be defined for each patient. 

Among the criteria for choosing the “best”, the type of central venous access most appropriate to the characteristics of each patient should be evaluated, considering the characteristics of the prescribed drugs, the device with the lowest rates of associated complications, appropriate durability for the treatment, cost for the institution and coverage of related expenses by health operators. Considering the search for a positive experience for the patient - his preference should be taken into account whenever possible. 

To specify a little more, considering patients undergoing Colorectal Cancer (CCR) with therapies predicting FOLFOX (5-FU, oxaliplatin and leucovorin), FOLFIRI (irinotecan, 5-FU and leucovorin), the recent article “Central Venous Catheter Insertion in Colorectal Cancer Patients, PICC or PC?, ”By the authors Lijuan Yin and Jinhua Li, from the Center of Oncology Province Hospital, evaluated 777 CCR patients, between January 2017 and January 2019. As a conclusion of this study, the authors found that the Port (fully implanted catheter) is associated with high cost, however, in the study, it was found lower rates of complications and costs resulting from complications when compared with patients who used PICC (long-term peripherally inserted central venous catheter). According to them, the result of the study becomes evidence to indicate the choice of port as an alternative for safe central access for colorectal cancer patients.

As there is not only an ideal solution for all protocols and not all patients, the article “PICC-Port totally implantable vascular access device in breast cancer patients undergoing chemotherapy”, Also published in 2020, in The Journal of Vascular Access by Sergio Bertoglio, et. al., concluded, after evaluating 418 patients, that the insertion of the Port through the peripheral route (in the arm) allows a safe and appropriate fully implanted access for patients with breast cancer.

Now, speaking of the Brazilian reality, in a live held by BMR Medical that proposed to discuss this scenario: PICC or Port, the pediatric surgeon Vilani Kremer, specialist in Oncology, PICC instructor by PAN (PICC Academy Network) WOCOVA, showed that individualization is the best way. 

“The planning of the catheter needs to include the patient's assessment, analysis of the pathology, treatment time, with the interval between chemotherapies. We need to open the options, planning the surgery and the tumor site. For example, we know that the flagship for solid tumors is fully implanted catheters, but sometimes the PICC catheter will be better for the patient. When expanding our options, we can come across the best being implanting the catheter fully implanted in the arm, for example ”, quotes Dr. Vilani Kremer. According to her, the search for problem solving must also include the maintenance of catheters. “We need to be clear that much more important than installing the device is the aseptic technique for accessing this catheter”, he points out.

If you want to watch the full class, visit: youtube / BMRMedical.

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