Needle Insertion Difficulty Algorithm (NIDA): A novel pilot study to predict Huber needle insertion difficulty in totally implanted devices

Abstract

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 ( p < 0.001), the SPIA type, if type 1, 2, or 3 ( p < 0.001) and the experience of the clinician ( p < 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.

Value of a novel Y-Z magnetic totally implantable venous access port in improving the success rate of one-time needle insertion

“…Studies have shown that the reasons for failure of Huber needle insertion include weight changes, the type of the device, the length of time the port has remained implanted, and the experience of the clinician performing the procedure ( 4 ). Therefore, currently, the first successful attempt at Huber needle insertion is often improved by strengthening the technical training of medical staff in clinical practice, while there is no effectively optimized design for the TIVAP device itself.…”

“…The traditional TIVAP has obvious advantages, but there are some limitations in practice. A study of 175 patients found that the success rate for one-time insertion of the Hong Kong needle was only 36% ( 4 ). Therefore, methods to improve the success rate of one-time insertion of the Huber needle are needed.…”

A novel Y-Z magnetic totally implantable venous access port based on the magnetic anchor technique

“…Studies have shown that the reasons for failure of Huber needle insertion include weight changes, the typology of the device, the length of time the port has remained implanted, and the experience of the clinician performing the procedure [4] . Therefore, currently, the rst successful attempt at Huber needle insertion is often improved by strengthening the technical training of medical staff in clinical practice, while there is no effectively optimized design for the TIVAP device itself.…”