• Medications

  • Anesthesia

    • Local anesthetic: 1% lidocaine

    • Conscious sedation: Fentanyl, midazolam

    • General anesthesia (if needed)

  • Prophylactic antibiotics

    • Based to local protocol

  • Management of co-morbidities  (allergy, blood glucose, blood pressure, nausea, etc)

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• Trolley/Equipment​

  • Cut down surgical kit

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• Checklist

  • CIRSE (IR Patient Safety Checklist)

  • LocSSIPs (Local Safety Standards for Invasive Procedures)

  • NatSSIPs (National Safety Standards for Invasive Procedures)

  • WHO (World Health Organization Surgical Safety Checklist)

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• Access

  • Supine position

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• Technique

  • Cleanse the skin over the port 

  • Cover with sterile drapes

  • Make an incision over the prior healed incision

  • Blunt dissect to free the port from the fibrin sheath

    • Ensure there are no anchoring stitches

  • Raise the line with a forceps and pull it out of the tunnel

  • Apply pressure at the neck for hemostasis

  • Close the incision

    • Subcutaneous: 2-0 or 3-0 absorbable sutures (Vicryl)

    • Subcuticular: 3-0 absorbable sutures (Monocryl)

    • Steri-Strips over incision

    • Dressing

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• Tips​

  • Attention not to fracture the line

    • Snare the line if it migrates into the vein

 

• Report

  • Describe the technique

  • Post-procedure instructions if needed