Vessel health and preservation, device selection and difficult intravenous access: CNSA vascular access devices evidence-based clinical practice guidelines.

Vessel health and preservation (VHP) described by Moureau and colleagues in 2012 is an evidence based, standardised strategy implemented in a healthcare organisation for the proactive, timely and standardised insertion and management of vascular access devices (VADs) for the individual patient and prescribed therapy.

The aim is to minimise pain, distress, and harm to the patient and maximise first time success to preserve vein health for current and future needs.

Due to the disease process, side effects of prescribed therapies (5) and frequent, repetitive or prolonged blood sampling requirements, patients with cancer have complex venous access requirements from the outset. The duration of therapies is potentially prolonged, months, years or indefinitely to control metastatic disease. VAD management may transverse numerous different healthcare teams and settings including inpatient, high acuity, ambulatory unit, subacute community care or home care.

Therapies can damage the tunica intima, inner lining of the vein including vesicant and irritant chemotherapy, clinical trial medications, supportive therapies for example antibiotics, mannitol, parenteral nutrition, and procedural drugs, such as contrast media. This is related to their irritant, vesicant, osmolarity and pH properties. Consequently, patients with cancer have a higher risk of poor vein health and venous depletion. Therefore, proactive, timely and informed VAD management from the start is critical.