To the Editor.—Long-term, intermittent administration of chemotherapy to patients with cancer is often difficult due to previous sclerosis of the peripheral surface veins by antineoplastic agents. Patients are then subjected to several unsuccessful attempts at venipuncture each time they receive chemotherapy and are at increased risk for extravasation, with subsequent tissue damage.
We have used two methods to solve this problem. A patient with poor veins who is likely to require chemotherapy on a long-term basis (six months or more) as an outpatient or inpatient receives either a Broviac (or Hickman) central venous catheter (useful especially in children [B. Eisenberg, MD, P. R. Exelby, MD, J. H. Raaf, MD, unpublished observation]), or a polytetrafluoroethylene (PTFE) arteriovenous graft placed in the arm or leg.1 The choice between these two techniques may be difficult, and depends on such factors as patient reliability, availability of personnel to manage catheter complications, and