Central Venous Catheter Care for the Patient With Cancer: American Society of Clinical Oncology Clinical Practice Guideline

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Key Recommendations

• There is insufficient evidence to recommend a specific type of CVC or insertion site, but femoral vein insertion should be avoided, except in certain emergency situations
• CVCs should be placed by well-trained health care providers
• Use of a CVC clinical care bundle is recommended
• Use of antimicrobial/antiseptic-coated CVCs and/or heparin-impregnated CVCs has been shown to be beneficial, but the benefits and costs must be carefully considered before they can be routinely used
• Prophylactic use of systemic antibiotics is not recommended before CVC insertion
• Cultures of blood from the CVC and/or tissue at the entrance-exit sites should be obtained before initiation of antibiotic therapy; most clinically apparent exit- or entrance-site infections as well as bloodstream infections can be managed with appropriate microbial therapy, so CVC removal may not be necessary; antimicrobial agents should be optimized once the pathogens are identified; catheter removal should be considered if the infection is caused by an apparent tunnel or port-site infection, fungi, or nontuberculous mycobacteria or if there is persistent bacteremia after 48 to 72 hours of appropriate antimicrobial treatment
• Routine flushing with saline is recommended
• Prophylactic warfarin and low–molecular weight heparin have not been shown to decrease CVC-related thrombosis, so routine use is not recommended
• Tissue plasminogen activator (t-PA) is recommended to restore patency in a nonfunctioning CVC; CVC removal is recommended when the catheter is no longer needed, if there is a radiologically confirmed thrombosis that does not respond to anticoagulation therapy, or if fibrinolytic or anticoagulation therapy is contraindicated