by Dr. C.H. Weaver M.D. Updated 01/2022
A venous access device (VAD) is a surgically implanted device that provides long-term access to a major vein. A VAD can be useful for patients undergoing systemic treatment with precision cancer medicines or chemotherapy because it allows for a single access that can be used repeatedly to draw blood and deliver medications thus avoiding frequent needle sticks. Although there are several different types of VADs, the two most commonly used for cancer treatment and taking blood samples are:
- Tunneled external catheters (Hickman® catheter), or
- Subcutaneous implanted ports (port-a-cath).
Both a Hickman® catheter and a port-a-cath are surgically implanted into a major vein. For the Hickman® catheter, the plastic tube or catheter is attached to a major vein and then comes out of the body for external access. A port-a-cath is implanted completely beneath the skin into a major vein under the collarbone. The port may then be accessed by a special needle through the skin to deliver chemotherapy, hydration, transfusions, and for taking blood samples.
The following are some key features that distinguish these two types of VADs:
- Easier insertion, removal, and access
- Higher flow capacity due to single, double, or triple lumen (channel)
- Fewer device-related infections
- Fewer activity restrictions
- Less day-to-day maintenance
- Lower flow capacity due to only single or double lumen (channel)
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Patients undergoing very demanding therapies that require frequent treatment, blood transfusions, and nutritional support—such as a stem cell transplant—may be required a Hickman® catheter instead of a port.
Who needs a VAD?
Not every patient requires a VAD. For some treatment plans, the inconvenience of implanting and accessing a VAD may outweigh the benefits. You may wish to ask your doctor if a VAD is an appropriate option for you, especially if you experience any of the following:
- You are extremely anxious about having needles inserted.
- Your veins are difficult to access or become inaccessible.
- You must have alternative veins in your foot or hand accessed, which may be associated with more discomfort.
- You are undergoing continuous infusion chemotherapy (over an hour).
- You anticipate many months of chemotherapy treatments.
- You are receiving intravenous chemotherapy that requires multiple needle sticks.
- Your treatment requires frequent drawing of blood samples.
- Your treatment strategy involves chemotherapy agents that may cause “vein pain” when administered through the arm.
- You have a physician or nurse who recommend a vascular access device.
What special precautions are necessary with a VAD?
Your VAD must be flushed in order for it to work properly. Flushing your VAD requires placing a needle in your port and flushing it out with heparin. Heparin is a blood thinner prevents the catheter (plastic tube) from becoming occluded (clogged). While you are on treatment, your VAD will be flushed after each treatment. When you are no longer on treatment you must still remember to have your VAD flushed regularly. This procedure needs to be done every 4-6 weeks. It is your responsibility to make the appointment to have your VAD flushed.