Cancer Practice Resource for Community Nursing Care Partners

Peter MacCallum Cancer Centre (Peter Mac) partners with community providers to deliver specialist cancer nursing care in the home, for Peter Mac patients living in regional and rural areas of Victoria. The cancer services provided by community partners include; Central Venous Access Device (CVAD) care, chemotherapy infusion disconnections and cancer treatment supportive care. This dedicated webpage resource provides information to assist community nurse partners in the delivery of care for Peter Mac patients in the community, as well as serving as a resource for nurses seeking information about cancer nursing care in the community. This webpage includes information on CVAD management, assessment and management of a neutropenic patient, drain management and frequently asked questions on community nursing care for patients receiving cancer treatment.

Central Venous Access Device (CVAD) Management

Peter Mac patients require a range of central venous access devices (CVAD’s) for cancer treatment and supportive care delivery. Devices inserted at Peter Mac  include Implanted Ports, Peripherally inserted central venous catheters (PICCs), and Tunnelled devices (Hickmans and Permacaths).

If the patient has been outsourced from Peter Mac @ Home to a partner community nursing provider, they will be discharged with written information regarding the type of CVAD inserted and provided with adequate equipment for CVAD care on discharge. 

Considerations when choosing the type of CVAD include, but are not limited to:

  • Patient diagnosis
  • Treatment requirements
  • Patient physical assessment
  • Previous CVAD history
  • The duration and type of therapy
  • Where the therapy is administered
  • Patient preferences, lifestyle & level of support

The Central Venous Access Device CVAD Principles of Management clinical guideline provides information on all aspects of CVAD assessment and management.

A catheter usually inserted percutaneously into the basilic or cephalic vein and threaded up the arm so that the catheter tip is positioned in the superior vena cava (SVC). These devices are used for treatment required for medium term (weeks-months).

provides information on PICC management - pages 5-10.

The following training video demonstrates the PICC dressing procedure:

Permacath: These devices are used for long term treatment (months-years). This type of catheter also has a large lumen width, enabling sufficient venous access for therapeutic apheresis procedures, including collection of haematopoietic progenitor cells, as well as haemodialysis. The tunnel creates distance between the exit site and the puncture entry site, reducing the risk of catheter-related blood stream infections.

Hickman: These devices are used for long term treatment (months-years).The tunnel creates distance between the exit site and the puncture entry site, reducing the risk of catheter-related blood stream infections.

The

provides information on how to complete a Hickman & Permacath dressing in the community. The Peter Mac Principles of CVAD Management Clinical Guideline outlines Tunnelled device management on pages 9-11.

The device is used for administration of fluids, blood products and medications and blood sampling. Implanted ports may be single or double lumen. These devices can be used for long term treatment (months-years). A surgically inserted CVAD consisting of a self-sealing silicone injection housed in a body of inert material, connected to a silicone catheter. The catheter is inserted into the venous system, typically placed with the tip positioned in the superior vena cava (SVC), but can be in the upper arm via the basilic or brachial vein or less commonly, can be implanted in the abdomen.

The

provides information on implanted port accessing and deaccessing. The Peter Mac Principles of CVAD Management Clinical Guideline outlines Implanted Port principles for management on pages 10-11.

If the patient is scheduled to come in to Peter Mac for an appointment, arrangements can be made on the day of the appointment for supplies to be sent home with the patient. If the patient is at home, call the Community Liaison Nurse on (03) 8559 5007 when equipment supplies are running low, to ensure sufficient time for express post delivery.

If a patient requires a script or medications related to their cancer diagnosis, please contact the community Liaison Nurse on (03) 8559 5007 to arrange for a script to be faxed to the patients’ local pharmacy.

If the medication requested is not related to their cancer diagnosis, the patient will need to follow up with their local GP.

Do not disconnect. Ensure the line is not clamped. If it appears to be infusing, contact [email protected] on (03) 8559 5007 to reschedule another visit.

If it does not appear to be infusing, contact [email protected] on (03) 8559 5007 to discuss booking the patient into the Peter Mac Chemotherapy Day Unit (CDU) for a medical review.

Refer to the Baxter Device Volume Guide to estimate the infusion time remaining.

Educate the patient re the importance of receiving the full dose and arrange for disconnection at completion time.

Clamp the line and see the EviQ hazardous drug spill management clinical guideline for direction on appropriate PPE and spill management. 

If a patient has an implanted port, they will need to attend either Peter Mac or their local emergency department to have the gripper needle replaced, and a heparin lock administered.

If the infusion is administered via a PICC or a tunnelled CVAD, the site will need to be assessed by the visiting nurse for signs of infection.

Ascertain approximate volume left when the device became disconnected. The patient may require a further dose and will need to attend Peter Mac to do so. 

Please call the Community Liaison Nurse on (03) 8559 5007 to advise, discuss further action required and document thoroughly.

The minimum education requirement for nurses administering cytotoxic drugs is completion of the Peter Mac Chemotherapy Module One (or an equivalent program), in addition to completion of the Peter Mac Cytotoxic Chemotherapy Competency Assessment Tool.

Your organisation may have an in house education program or alternatively utilise resources available from EdCaN or eviQ.

Speak with your manager regarding your organisations' requirements.

A cytotoxic spill refers to both a liquid or powder spill of a cytotoxic drug and/or the bodily fluids of the patient within 7 days of administration of a cytotoxic drug. Equipment used in this situation can be disposed of in a sealed cytotoxic waste bag (purple) and placed in a cytotoxic bin (purple). 

The 

 provides direction to all staff involved in the safe management of a cytotoxic or hazardous non-cytotoxic drugs spill.

See ActiVAC Alarm Trouble Shooting Guide.

Alternatively KCI Customer Service Call Centre professionals are available 24/7:

Phone: 1300 KCI VAC (1300 524 822)

Fax: 1800 KCI VAC (1800 524 822)

Email: [email protected]

Peter Mac patients may have a drain tube in situ on discharge.  The following drain tubes are utilised at Peter Mac.. All Peter Mac patients will be discharged with a  relevant written drain tube removal order. 

- Exudrain

- Bellovac

- Surimex

- Jackson Pratt

- Pigtail

For further information on the management of these devices, please refer to

 clinical procedure.