title: Central venous catheter care for the patient with cancer: American Society of Clinical Oncology clinical practice guideline.
abstract: OBJECTIVE
  To develop an evidence-based guideline on central venous catheter (CVC) care for patients with cancer that addresses catheter type, insertion site, and placement as well as prophylaxis and management of both catheter-related infection and thrombosis.
  
  
  METHODS
  A systematic search of MEDLINE and the Cochrane Library (1980 to July 2012) identified relevant articles published in English.
  
  
  RESULTS
  The overall quality of the randomized controlled trial evidence was rated as good. There is consistency among meta-analyses and guidelines compiled by other groups as well.
  
  
  CONCLUSIONS
  There is insufficient evidence to recommend one CVC type or insertion site; femoral catheterization should be avoided. CVC should be placed by well-trained providers, and the use of a CVC clinical care bundle is recommended. The use of antimicrobial/antiseptic-impregnated and/or heparin-impregnated CVCs is recommended to decrease the risk of catheter-related infections for short-term CVCs, particularly in high-risk groups; more research is needed. The prophylactic use of systemic antibiotics is not recommended before insertion. Data are not sufficient to recommend for or against routine use of antibiotic flush/lock therapy; more research is needed. Before starting antibiotic therapy, cultures should be obtained. Some life-threatening infections require immediate catheter removal, but most can be treated with antimicrobial therapy while the CVC remains in place. Routine flushing with saline is recommended. Prophylactic use of warfarin or low-molecular weight heparin is not recommended, although a tissue plasminogen activator (t-PA) is recommended to restore patency to occluded catheters. CVC removal is recommended when the catheter is no longer needed or if there is a radiologically confirmed thrombosis that worsens despite anticoagulation therapy.
authors: Karmanos Cancer Institute, Wayne State UniversitySchool of Medicine, Detroit, MI, USA.
authors: Charles A
authors: CA
authors: Schiffer
authors: Pamela B
authors: PB
authors: Mangu
authors: James C
authors: JC
authors: Wade
authors: Dawn
authors: D
authors: Camp-Sorrell
authors: Diane G
authors: DG
authors: Cope
authors: Bassel F
authors: BF
authors: El-Rayes
authors: Mark
authors: M
authors: Gorman
authors: Jennifer
authors: J
authors: Ligibel
authors: Paul
authors: P
authors: Mansfield
authors: Mark
authors: M
authors: Levine
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D055499:Catheter-Related Infections / Q000382:microbiology / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000379:methods*; D062905:Central Venous Catheters / Q000382:microbiology; D006801:Humans; D008495:Medical Oncology / Q000379:methods* / Q000458:organization & administration; D015201:Meta-Analysis as Topic; D009369:Neoplasms / Q000628:therapy*; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic / Q000379:methods / Q000592:standards; D013927:Thrombosis / Q000517:prevention & control; D014481:United States
chemical_list: D000890:Anti-Infective Agents; D000925:Anticoagulants