(52) Access or no access? How to assess the success of chemotherapy administration via PIV in the adolescent Hodgkin lymphoma population

Title: Access or no access? How to assess the success of chemotherapy administration via PIV in the adolescent Hodgkin lymphoma population

Abstract : Approximately 1000 children and adolescents are diagnosed with Hodgkin lymphoma each year in the United States. Most of these diagnoses are seen in the adolescent age group, particularly in patients between 15-19 years old, and treatment usually involves administration of parenteral chemotherapy. Often, adolescent/ young adult patients are given the option of receiving their chemotherapy via peripheral IV (PIV) instead of undergoing placement of central venous access. Many of these patients experience complications because of peripheral administration of chemotherapy agents, such as pain during infusions, thrombophlebitis, thrombus requiring anticoagulation, infiltration and extravasation. Frequent use of veins also may lead to lack of access options as the treatment course progresses necessitating emergent central access placement, sometimes delaying chemotherapy. There is a paucity of data surrounding the best way to assess potential for success in offering peripheral chemotherapy administration to adolescent patients. Through literature review, potential evaluation tools were identified and assessed to ascertain the possibility of implementation within the pediatric HL population, with the goal of minimizing complications of access, allowing for better provision of appropriate chemotherapy, and maximizing quality of life of adolescent patients. The DIVA (“difficult intravenous access”) score was developed to identify children at risk for difficult intravenous access in emergency room setting. Utilizing a 4 variable model to assess potential for successful IV placement, it has been validated by an independent group. Furthermore, it has been modified to be utilized within an adult population, termed A-DIVA, which may be more appropriate for an adolescent/young adult population, as well as implemented successfully within adult oncology programs. The DIVA or modified A-DIVA could be used as an initial intervention aimed at preliminary assessment of venous access potential, with acknowledgment that it may require further modification to address the unique needs of the adolescent/young adult HL population.