• 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)

​

• Trolley/Equipment​

  • Cut down surgical kit

​

• 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)

​

• Access

  • Supine position

​

• Technique

  • Cleanse the skin over the port 

  • Cover with sterile drapes

  • Attempt to free the cuff from the tunnel’s entry site or make an incision over cuff

  • Blunt dissect to free the cuff from the fibrin sheath

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

  • Apply pressure at the neck for hemostasis

  • Close the incision:

    •  Absorbable sutures 3-0

    • Steri-Strips over incision

    • Dressing

​

 

• 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