Medical Oncology Unit, Oncohematology Department, Monsignor Dimiccoli Hospital Barletta, ASL BT, Barletta, Italy.
Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari Aldo Moro, Bari, Italy.
J Vasc Access. 2023 May;24(3):492-496. doi: 10.1177/11297298211040343. Epub 2021 Aug 18.
Safeguarding of venous assets in cancer patients provides for positioning vascular devices. In totally implanted central venous access devices, hereinafter referred as TIVADs, it's necessary introducing Huber needle, into subcutaneous port, to use it. This procedure is not easy for all implanted devices. The procedural difficulty is to be attributed both to the type of the implanted port and to the skill of the clinician. The degree of patient satisfaction is variable and related with the clinician performing the maneuver. It follows a professional dissatisfaction of the clinician and a hesitation of the patient. Moreover, the incorrect positioning of the Huber needle into the port, could lead to the infusion of antiblastic drugs into the subcutaneous tissue with the consequent tissue damage due to extravasation of the drugs. Evaluation of different characteristics of TIVADs, allowed grouping them, in different types, setting up the S.P.I.A. method (Subcutaneous Port Investigator Assessment). Collected data from medical records concerning: primary pathology, port's permanence and using, Huber needle insertion failed events, if a vascular access expert/specialist clinician has been called, weight gain or loss were recruited. These data made it possible to determine the types of implanted ports that were most difficult to insert the Huber needle, creating the N.I.D.A. (Needle Inserting Difficulty Algorithm) as a prognostic index of Huber needle inserting into the port. In particular, the type of implanted port, that is, if it was a brachial or thoracic implant ( < 0.001), the SPIA type, if type 1, 2, or 3 ( < 0.001) and the experience of the clinician ( < 0.001) were considered as predictors of a successful first attempt and then can perform the NIDA. The relevant aspects in the success of the procedure are therefore the type of port (thoracic or brachial), the SPIA type, and the experience of the clinician in the successful insertion of the Huber needle into the port at the first attempt.
保护癌症患者的静脉资产需要定位血管设备。在完全植入式中央静脉通路装置（下文简称 TIVAD）中，需要将 Huber 针引入皮下端口才能使用。但并非所有植入设备都能轻易完成这一操作。操作难度既与植入端口的类型有关，也与临床医生的技能有关。患者的满意度因人而异，与执行操作的临床医生有关。这会导致临床医生的不满和患者的犹豫。此外，如果 Huber 针未正确定位到端口内，可能会导致抗肿瘤药物注入皮下组织，从而导致药物外渗引起的组织损伤。评估 TIVAD 的不同特征，将它们分为不同类型，建立 S.P.I.A. 方法（皮下端口评估）。从病历中收集的数据包括：主要病理、端口的持久性和使用情况、Huber 针插入失败事件，如果调用了血管通路专家/专科临床医生、体重增加或减轻等。这些数据可确定最难插入 Huber 针的植入端口类型，创建 N.I.D.A.（针插入难度算法）作为预测 Huber 针插入端口的预后指标。特别是植入端口的类型，如果是臂部或胸部植入（ < 0.001）、SPIA 类型，如果是 1、2 或 3 型（ < 0.001）以及临床医生的经验（ < 0.001）被认为是首次尝试成功的预测因素，然后可以执行 NIDA。因此，该操作成功的相关因素是端口类型（胸部或臂部）、SPIA 类型以及临床医生在首次尝试中成功将 Huber 针插入端口的经验。
