INTRODUCTION: The management of patients with advanced gastric cancer requires a stable venous access required at different stages of disease (treatment phase, palliative phase). Totally implantable central venous access in the arm, named PICC-PORT, is used in a patient with results of extensive skin burns of the neck, chest and right arm and surgical outcomes of multiple skin grafts of chest. The described clinical case is the first event in the scientific literature.
PRESENTATION OF CASE: We report a case of a patient with results of extensive skin burns of the neck, chest and right arm and surgical outcomes of multiple skin grafts of chest that must perform chemotherapy with a port. In this patient, due to the difficulty of implanting a door in the cervico-thoracic district, we opt for the totally subcutaneous implantation of the vascular device (PICC-PORT 5 Fr) in the left arm.
DISCUSSION: In this patient for the difficulty of implanting a port in the cervico-thoracic district, we opt for the totally subcutaneous implantation of the vascular device (PICC-PORT) in the arm. The PICC-PORT is positioned with the same technique as the PICC (ultrasound-guided vein puncture, with modified Seldinger technique and tip location with ECG technique); presents all the functional and aesthetic advantages of a totally subcutaneous device.The case described is the first case in the scientific literature.
CONCLUSION: In Europe in recent years for the availability of the vascular device of small dimensions and materials increasingly compatible, the “PICC-PORT” is positioned in the veins of the arm with ultrasound-guidance without complications such as pneumothorax, arterial puncture, hematoma of the neck, Pinch-off syndrome, such as the clinical case presented with extensive scars on the chest and neck. Thoracic devices (chest port, tunnel venous catheter) are not indicated in thickened and inelastic skins, due to the high risk of dehiscence of the surgical wound.
Reference:Merlicco, D., Lombardi, M. and Fino, M.C. (2020) PICC-PORT: Valid indication to placement in patient with results of extensive skin burns of the neck and chest in oncology. The first case in the scientific literature. International Journal of Surgery Case Reports. February 19th. doi: 10.1016/j.ijscr.2020.02.028. (Epub ahead of print).