Chemotherapy agents can be delivered by different routes, but are most commonly administered intravenously. Typically, a peripheral cannula is used, although implantable devices including peripherally inserted central catheters, portacaths, or central venous catheters may be required. Arteriovenous (AV) fistulas have not been utilised at this institution for administration of chemotherapy.
To use a pre-existing mature AV fistula for chemotherapy treatment in a haemodialysis patient.
In April 2016, a 51-year old lady with a new diagnosis of limited-stage small cell lung cancer was referred to our service for further management. She had a history of chronic end-stage renal disease and had been on home haemodialysis for ten years. She had a mature functioning AV fistula in her forearm. Chemotherapy with 3-weekly Cisplatin and Etopophos for four cycles was proposed.
Our hospital policy stated that AV fistulas are only to be used for the purpose of haemodialysis with the exception of an emergency situation. Venous access is an important lifeline in patients on long-term haemodialysis and it was paramount that there be minimal venous access attempts for this patient.
Discussions was held with a multi-disciplinary team including medical and nursing staff from the Renal and Medical Oncology disciplines, Director of Medical Services, Nursing Executive and Patient Safety. It was agreed that pre-existing AV fistulas could be used for chemotherapy administration following appropriate training and accreditation of nursing staff in the chemotherapy unit.
Ultrasound was performed prior to and following chemotherapy administration to check patency, pressure and elasticity of the device.
The patient successfully completed four cycles of chemotherapy without complication using the AV fistula.
Chemotherapy can be safely delivered by an AV fistula. This requires multi-disciplinary team work with appropriate training and education for staff. Importantly, this preserves venous access for patients on long-term haemodialysis.