Future Investigation

Abstract

Development of new teaching tools in the field of central venous access, especially with the use of computerized programs and simulators, will be able in the near future to improve the skill and practical training of young doctors. Three-dimensional multiplanar and volume-rendered views are now allowing the simultaneous view of the neck anatomy in 3 orthogonal planes, with the potential to confer a safety benefit to the patients. A number of measures have been implemented to reduce the risk of infections, including maximal barrier precautions during catheter insertion, catheter site maintenance, and hub handling. New technologies and materials will be available in the near future, and will need appropriate trials. Implementation of educational interventions has proven to significantly decrease infection rates, and this will help support a culture of zero tolerance for infection. Thrombosis still remains a major problem. Areas that warrant further research include the benefit of prophylaxis in the ambulatory setting, the risk/benefit ratio of prophylaxis for hospitalized patients with cancer, an understanding of incidental venous thromboembolism, and the impact of anticoagulation on survival. Future prevention studies should aim to achieve a better understanding of the risk factors for thrombosis, thus contributing to a better definition of the patient population at risk; certain patient groups, including those with a hematologic malignancy undergoing intensive chemotherapy, as well as those with hereditary thrombophilia or with a history of unprovoked thrombosis, may have an elevated risk of developing this complication, making them reasonable candidates for prophylaxis.