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ARM!PORT!IN!ONCOLOGY:!EXPERIENCE!FROM!2012!
Authors:)D.)Merlicco
1,)G.)Roggia
1,)M.)Lombardi
2,)M.C.)Fino
2,)R.)Marzaioli
3)
! 1U.O.C!di!Chirurgia!Generale,!P.O.!“F.!Lastaria”!di!Lucera!(Fg)!ASL!FG! 2D.H.!di!Oncologia,!P.O.!“F.!Lastaria”!di!Lucera!(Fg)!ASL!FG! 3Università!degli!Studi!di!Bari!“Aldo!Moro”!U.O.C.!“A.!De!Blasi”!! ! !
Introduzione!
!The! management! of! patients! with! cancer! requires! a! stable! venous! access!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! required!at!different!stages!of!disease!(diagnostic!phase,!treatment!phase,!palliative!phase).!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Central! venous! catheters! (PICC,! PORT,! CVC)! are! devices! that! ensure! safe! infusions! of!
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Materials!and!methods!
The! arm! ports! implanted! in! our! Unit! of! General! Surgery! in! the! period!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
between! 01/2012! and! 09/2014! were! 42,! in! patients! aged! between! 39! and! 70! years.!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Patients!undergoing!this!procedure!are!all!cancer!(gastrointestinal!cancer,!breast!cancer,!lung!
cancer).!!
All! placement! procedures! were! performed! in! the! operating! room! and! used! a! silicone! port! (MiniGSitiplant!6.6!FrGVygon).!
You!have!performed!a!careful!study!of!ultrasound!of!peripheral!veins!of!the!arm!to!locate!the! neurovascular! bundle! and! the! central! veins;! for! venipuncture! were! chosen! the! basilic! vein! and!brachial!vein!inside!of!the!dominant!arm;!they!have!been!identified!and!puncture!under! ultrasound! guidance! to! prevent! punctures! to! veins! of! small! caliber! compared! to! central! venous!catheter,!accidental!punctures!the!artery!and!nerve.!Referring!to!the!procedures!for! placement!of!a!PICC,!the!catheter!of!the!Arm!port!was!placed!with!the!same!procedures!as!the! PICC! to! the! proximal! 1/3! of! the! arm,! and! later! was! created! with! a! surgical! incision! a! subcutaneous! pocket! of! 2! cm,! inferiorGmedial! to! sting,! to! accommodate! the! reservoir! of! the! port!located!on!the!2/3!arm!in!the!inner!portion;!the!latter!was!placed!above!the!plane!muscle! and!medial!to!the!nerve!and!vascular!structures!(brachial!artery!and!median!nerve)!that!could! be!damaged!during!the!creation!of!the!subcutaneous!pocket.!
At! this! point! you! ran! the! control! of! the! tip! of! the! CVC! with! method! ECG! and,! after! a! short! subcutaneous!tunneling!of!the!CVC,!the!two!systems!(cvc!and!reservoirs)!have!been!connected! and!checked!functionality.!The!reservoir!in!the!subcutaneous!pocket!has!never!been!pegged!to! the!muscular!plane.!At!the!end!of!the!procedure!was!performed!the!surgical!suturing!of!the! subcutaneous!tissue!of!the!breach!with!3/0!vicryl!and!the!skin!sutured!with!a!monofilament! with!intradermal!polypropylene;!important!for!the!first!24!hours!to!perform!a!dressing!of!the! arm! port! with! sterile! gauze! and! slight! compression! of! the! wound! with! adhesive! elastic! bandage!to!avoid!in!the!early!postGoperative!rotation!of!the!reservoir!on!cvc.!You!run!to!the! end!of!the!procedure,!in!addition,!a!chest!XGray!in!two!projection!to!document!the!location!of! the!catheter!tip!and!the!absence!of!Kinking!of!cvc!along!its!course.!! Perioperative!complications!were!nil!for!PNX,!Arterial!Puncture,!primary!malposition,!while! there!are!complications!post!procedural!1!case!of!infection!by!Staphylococcus!aureus,!and!one! subcutaneus!extravasation.! ! !
Results!
The!implantation!of!arm!port!was!performed!on!42!patients!of!138!(from!2012!to!09/2014)! with!a!success!of!the!procedure!of!100%;!the!catheter!was!always!placed!in!the!dominant!arm! (for!larger!diameters!of!the!veins);!the!vein!of!choice!for!USGguided!puncture!was!70%!of!the! internal! brachial! and! the! remaining! 30%! of! the! basilic! vein;! has! never! been! stung! in! this! study,! the! cephalic! vein.! There! were! no! early! postoperative! complications! (hematoma,! bleeding,!displacements,!rotations,!detachment!of!the!CVC!from!the!reservoir).!!A! late! complication,! however,! occurred! thirty! days! after! implantation:! an! infection! of! the! subcutaneous! pocket! and! cvc! from! Staphylococcus! aureus! which! led! the! authors! to! explant! the!device!fully!implantable!infected.!!
The!outcomes!two!years!after!implantation!is!optimal,!and!the!patient!is!satisfied!in!terms!of! aesthetic!and!social!reintegration.!
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Discussion!!
Starting!from!experience!in!the!implant!of!PICC,!the!installation!of!the!Arm!Port!is!safe,!!
and! our! experience! of! 42! plants! from! the! arm! port! 01/2012! and! 09/2014! proves! it.!!!!!!!!!!!!!!!!!!! The!indication!for!implantation!of!the!Arm!Port!is!the!cancer!patient,!and!specifically:!patients!
with!head!and!neck!cancer,!patients!with!Radiodermatitis!by!radiation!therapy!for!head!and! neck! cancer,! patients! with! ostomies! (tracheobronchial! /! esophagusGostomy),! patients! with! severe!kyphosis,!patients!with!breast!implants!bilaterally.!!
The!decision!to!place!the!port!in!the!arm!sprang!from!dissatisfaction!of!some!patients!with! breast!cancer!who!refused!the!port!in!the!chest!and!arm!PICC!mainly!for!aesthetic!reasons!and! for!convenience.!!
