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Challenging the Distal-to-Proximal Cannulation Technique for Administration of Anticancer Therapies: A Prospective Cohort Study

Chan, Raymond Javan MAppSc (Research), BN, RN, FRCNA; Alexander, Alison RN; Bransdon, Maree MN, RN; Webster, Joan BA, RN, RM; Hughes, Brett Gordon Maxwell MBBS(Hons), BSc(Med), FRACP; Brown, Leisa MN, BN, RN; Graham, Therese BN, RN

doi: 10.1097/NCC.0b013e3182352916

Background: Distal-to-proximal technique has been recommended for anticancer therapy administration. There is no evidence to suggest that a 24-hour delay of treatment is necessary for patients with a previous venous puncture proximal to the administration site.

Objectives: This study aims to identify if the practice of 24-hour delay between a venous puncture and subsequent cannulation for anticancer therapies at a distal site is necessary for preventing extravasation.

Methods: A prospective cohort study was conducted with 72 outpatients receiving anticancer therapy via an administration site distal to at least 1 previous venous puncture on the same arm in a tertiary cancer center in Australia. Participants were interviewed and assessed at baseline data before treatment and on day 7 for incidence of extravasation/phlebitis.

Results: Of 72 participants with 99 occasions of treatment, there was 1 incident of infiltration (possible extravasation) at the venous puncture site proximal to the administration site and 2 incidents of phlebitis at the administration site.

Conclusion: A 24-hour delay is unnecessary if an alternative vein can be accessed for anticancer therapy after a proximal venous puncture.

Implications for Practice: Infiltration can occur at a venous puncture site proximal to an administration site in the same vein. However, the nurse can administer anticancer therapy at a distal site if the nurse can confidently determine that the vein of choice is not in any way connected to the previous puncture site through visual inspection and palpation.

Author Affiliations: Cancer Care Services (Mr Chan; Mss Alexander, Bransdon, Brown, Graham; and Dr Hughes) and Centre for Clinical Nursing (Prof Webster), Royal Brisbane and Women’s Hospital, Queensland, Australia; School of Nursing and Midwifery (Mr Chan, Prof Webster) and School of Medicine (Dr Hughes), University of Queensland, and School of Nursing and Midwifery, Queensland University of Technology (Prof Webster), Brisbane, Australia; Research Centre for Clinical Practice Innovation, Griffith University, Nathan, Queensland, Australia (Mr Chan, Prof Webster).

The authors have no funding or conflicts of interest to disclose.

Correspondence: Raymond Javan Chan, MAppSc (Research), BN, RN, FRCNA, Nurse Researcher, Cancer Care Services, Royal Brisbane and Women’s Hospital, Herston Q4029, Australia (

Accepted for publication August 29, 2011.

© 2012 Lippincott Williams & Wilkins, Inc.