Unit of Anesthesia and Intensive Care Medicine, Vascular Access Team, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy.
Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy.
J Vasc Access. 2024 Nov;25(6):1713-1720. doi: 10.1177/11297298231209521. Epub 2023 Nov 13.
In the last decade, a new type of brachial port has been introduced in clinical practice, the so-called "PICC-port." This is a brachial port, but inserted according to the methodologies and technologies currently adopted for the insertion of peripherally inserted central catheters (PICCs). Several studies have shown that PICC-port insertion is safe, not associated with any relevant immediate or early complication, and that the expected incidence of late complications is significantly lower if compared to "traditional" brachial ports (i.e. inserted without ultrasound guidance). Furthermore, PICC-ports yield excellent esthetic results and are associated with optimal patient compliance. This paper describes an insertion bundle-developed by GAVeCeLT, the Italian Group of Long Term Venous Access Devices, and nicknamed "SIP-Port" (Safe Insertion of PICC-Ports)-which consists of few evidence-based strategies aiming to further minimize all immediate, early, or late complications potentially associated with PICC-port insertion. Also, this insertion bundle has been developed for the purpose of defining more closely the differences between a traditional brachial port and a PICC-port. The SIP-Port bundle is currently adopted by all training courses on PICC-port insertion held by GAVeCeLT. It includes eight steps: (1) preprocedural ultrasound assessment utilizing the RaPeVA (Rapid Peripheral Venous Assessment) protocol; (2) appropriate skin antiseptic technique and maximal barrier precautions; (3) choice of appropriate vein, in terms of caliber and site; (4) clear identification of the median nerve and of the brachial artery during the venipuncture; (5) ultrasound-guided puncture and cannulation of the vein; (6) ultrasound-guided tip navigation; (7) intra-procedural assessment of tip location by intracavitary ECG or by trans-thoracic echocardiography; (8) appropriate creation and closure of the subcutaneous pocket.
在过去的十年中，一种新型的肱动脉端口已在临床实践中引入，即所谓的“PICC 端口”。这是一种肱动脉端口，但根据目前用于插入外周插入中心导管（PICC）的方法和技术进行插入。多项研究表明，PICC 端口插入是安全的，与任何相关的即时或早期并发症无关，如果与“传统”肱动脉端口（即没有超声引导插入的端口）相比，预期的晚期并发症发生率明显较低。此外，PICC 端口可获得出色的美观效果，并与最佳的患者依从性相关。本文描述了由 GAVeCeLT（意大利长期静脉通路装置组）开发的一种插入套件，名为“SIP-Port”（安全插入 PICC 端口）-它由少数基于证据的策略组成，旨在进一步最小化与 PICC 端口插入相关的所有即时、早期或晚期并发症。此外，该插入套件的开发目的是更紧密地定义传统肱动脉端口和 PICC 端口之间的差异。SIP-Port 套件目前被 GAVeCeLT 举办的所有 PICC 端口插入培训课程采用。它包括八个步骤：（1）使用 RaPeVA（快速外周静脉评估）协议进行术前超声评估；（2）适当的皮肤消毒技术和最大的屏障预防措施；（3）根据口径和位置选择合适的静脉；（4）在静脉穿刺过程中清楚识别正中神经和肱动脉；（5）超声引导下的穿刺和静脉插管；（6）超声引导下的尖端导航；（7）通过腔内心电图或经胸超声心动图在术中评估尖端位置；（8）适当的皮下口袋的创建和闭合。
