In the presence of availability of deep veins of the arm (brachial - basilica - axillary), the placement of a brachial port (or 'PICC port') must be taken into consideration.
PICC-ports - if compared to chest ports - have many advantages, such as for example the minimization of insertion-related complications and better outcome in cosmetic and psychological terms (less obvious reservoir, absence of scar in visible area, etc.). The use of PICC-ports has also some specific indications:
- scheduled radiotherapy in the thoracic area;
- presence/prediction of cutaneous/muscular problems in the thoracic region (tracheostomy complicated by skin lesions; possible cetuximab-related folliculitis; use of the pectoral muscle for reconstruction after cervical surgery; etc.);
- patient preference for psychological/cosmetic reasons.
The use of PICC-port also has specific contraindications:
- the presence of a chronic renal insufficiency stage 3b-4-5 (and therefore presence or forecast of arteriovenous fistula for hemodialysis)
- bilateral contraindications to the implant in the arm due to osteo-articular (e.g. pathological fractures), neuro-muscular (e.g. paresis, plegia), lymphatic (e.g., complete lymph node dissection of the axillary cavity for breast cancer surgery), or vascular issues (previous venous thrombosis)
- need for night use of the device, for example for continuous infusion > 12 hours. Infusion maintenance during sleep could in fact be associated with the risk of dislocation of the Huber needle inserted in the reservoir placed in the arm.
PICC-ports have an incidence of immediate and early complications certainly inferior to chest ports; the data currently available in the literature suggest that there are is significant difference between PICC-ports and chest ports in terms of late complications (infection, venous thrombosis, lumen occlusion, reservoir complications).