Introduction

Chemotherapy, in cancer patients, relies mostly on infusion of antiblastic drugs and immunotherapy, intravenously, by central venous catheters, for safe administration. Totally implantable vascular devices, such as brachial and thoracic ports, require the insertion of Huber's needle inside the port, implanted in the subcutaneous tissue, percutaneously, in order to be used. This results in expected procedural pain on the part of the patient; sometimes the insertion of Huber's needle into the port fails on the first attempt, and therefore further attempts by clinicians are necessary.

Materials & Methods

Through a technical evaluation based on direct visualization and palpation, the naked eye visibility, palpability, mobility, and possible retroversion of the subcutaneous implant were assessed, classifying each implant into three different categories for both brachial and thoracic ports by classifying them according to their degree of maneuver difficulty. This assessment allowed to realize the S.P.I.A. (Subcutaneous Port Investigator Assessment) Method, predictive of difficulty of the Huber’s needle insertion into the port. It was subsequently created the N.I.D.A. (Needle Insertion Difficulty Algorithm), a decision-making algorithm that pairs each SPIA type with the appropriate experience of the clinician performing the procedural maneuver.  Assessment of pain during the procedural maneuver using the N.R.S. (Numeric Rating Scale) both on the first attempt and on subsequent repeated attempts to insert Huber's needle into the subcutaneous port.

Results

The SPIA types, T1, T2, and B1, were easier in the Huber’s needle insertion Huber into the port, by clinicians with a basic experience; instead, the SPIA types, T3, B2, and B3, were found to involve the highest number of failed procedural attempts and have requested the intervention of more experienced clinicians or specialists. The pain perceived on the first attempt to insert the Huber's needle into the subcutaneous port was significantly less than the pain perceived on repeated subsequent attempts.

Conclusions

The Proactive approach, in the implementation of the S.P.I.A. Method and the N.I.D.A., allows the zeroing of unsuccessful attempts of the procedural maneuver of inserting Huber's needle into the port, containing the perception of procedural pain.

Acknowledgements: prof. Lucia Lombardi for her advice and support

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