The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on stent placement for vena caval obstruction.
Vena caval obstruction is narrowing or occlusion of the caval veins (the inferior vena cava or the superior vena cava), which return blood from the body to the heart. It is most commonly caused by cancer, especially lung cancer. Patients with malignant vena caval obstruction are very unwell and have a short life expectancy.
Standard treatments for malignant caval obstruction include radiotherapy and chemotherapy. These can cause severe adverse events and response to treatment may take several weeks. Stent placement can replace or supplement these treatments.
Stent placement for vena caval obstruction is a minimally invasive procedure that involves inserting a catheter into a large vein, usually in the groin, and passing it into the narrowed area under X-ray control. A stent, which may be self-expanding or balloon-dilated, is then positioned across the area of narrowing to relieve it.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.