Patients with metastatic cancer frequently require Peripherally Inserted Central Catheters (PICCs) to deliver chemotherapy in the ambulatory setting. PICCs have a higher incidence of Venous Thrombo-Embolism (VTE), infections, need to be removed when patients have a treatment break and also require weekly flushes. They also interfere with daily activities such as bathing and can preclude patients from swimming or going on long holidays. At the time, TIVAD’s were not available in our trust. To reduce line complications and improve quality of life I was keen to develop a service at my hospital for patients with metastatic cancer. The process took 2 years to develop from initial idea to inserting the first TIVAD, however I am now pleased to report that I have gained competency, inserted over 30 TIVADs in the first 3 months and am now training up another nurse.
I was keen to explore the potential to introduce a nurse-led TIVAD service that wouldn’t need any form of x-ray guidance using ECG and Ultrasound technology. I contacted a vascular access company who were able to supply 1:1 clinical training until competency was achieved. I also contacted a local charity who agreed to raise money for the ultrasound machine; we also used legacies donated by 2 patient’s families who had left donations to be spent on developing the service as they had felt their quality of life had been impacted upon by frequent PICC insertions.
A total of 30 patients have had TIVADs inserted and we are now running independent nurse-led lists every week to ensure that all patients with metastatic cancer can have a TIVAD inserted. Plans are afoot to formally audit the service and patients receiving treatment for metastatic cancer have already been able to swim and benefit from not having to attend for weekly flushes. There has been 1 VTE and no infections in the TIVAD group, compared to the previous 30 PICC insertions where there were 5 episodes of VTE and 3 line infections over the same period of time.
The introduction of a nurse-led TIVAD service is already delivering significant improvements for the quality of life of patients with metastatic cancer. Patients are no longer having multiple PICCs and we have already seen a reduction in VTE and infections.
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