‘Pinholes in my arms’: the vicious cycle of vascular access

Central venous access devices (CVADs) are necessary for the delivery of intravenous (IV) therapies but are damaging to the inner layer (intima) of small peripheral veins (Al-Benna et al, 2013). They are typically used for vesicant chemotherapy agents, which can cause tissue necrosis if they extravasate out of the vein (Schulmeister, 2011). CVADs are also recommended for longer term IV therapies as they can remain in place for prolonged periods of time. This reduces the need for continued, repeated cannulation, allowing preservation of peripheral vessels (Gorski et al, 2021).

Over the years, technological advances have resulted in three main device types for the delivery of drugs into the central venous system: peripherally inserted central catheters (PICCs) and tunneled central venous catheters (TCVCs), which are both external devices, and totally implanted vascular access devices (TIVADs), which are inserted under the skin. Depending on the treatment, patients can have these devices in place for periods ranging from a few months to many years. Currently, there are limited studies that have explored, in depth, the lived experiences of patients with CVADs and how they make sense of their experiences. A review of the literature by the authors before the study discussed in this article highlighted that the meaning attributed to the experiences of living with a CVAD has not been explored. Consequently, in the UK literature, evidence of how patients make sense of this experience is lacking. Although some qualitative research has been conducted, it is argued that an alternative stance should be taken to provide a richer, unique insight and, consequently, gain a deeper understanding of the experiences of patients living with these devices. Therefore, more in-depth, exploratory research is warranted to help improve understanding of the experience of living with a CVAD.