The following article features coverage from the European Society for Medical Oncology (ESMO) Congress 2019. Click here to read more of Oncology Nurse Advisor‘s conference coverage.

A nurse-led service of delivering totally implantable vascular access devices (TIVADs) is changing the playing field by reducing the number of catheter-associated complications and improving the quality of life for patients with metastatic cancer. The results of a small nurse-led program implemented at a hospital in Birmingham, United Kingdom, was presented at ESMO Congress 2019 in Barcelona, Spain.

Patients with metastatic cancer typically receive a peripherally inserted central catheter (PICC) for the administration of chemotherapy. However, PICCs are associated with a higher incidence of venous thromboembolism (VTE) and infections. They also need to be removed during treatment breaks and require weekly flushes. Patients often find PICCs inconvenient as they interfere with daily activities such as bathing, swimming, or even going on vacation for long periods of time.

In a process that took 2 years, Matthew N. Fowler, MSc, developed a nurse-led TIVAD service that would not need any form of radiographic guidance using ECG. He received personalized clinical training and raised funds from several sources to purchase a required ultrasound machine. He has since shared his training with his fellow nurses and has since implemented a nurse-led program.

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To date, 30 patients have received nurse-inserted TIVADs. One episode of VTE and no infections have occurred in the TIVAD group. In a previous group of 30 PICC insertions, 5 episodes of VTE and 3 infections occurred. Patients in the TIVAD group also report their ability to swim and the benefit of not undergoing weekly flushes. “The introduction of a nurse-led TIVAD service is already delivering significant improvements for the quality of life of patients with metastatic cancer,” wrote Mr Fowler.


Fowler MN. Introduction of a nurse-led totally implantable vascular access device (TIVAD) service for patients with metastatic cancer. Presented at: ESMO Congress 2019; September 27-October 1, 2019; Barcelona, Spain. Abstract CN34.