PICC-ports - as suggested by the term - are brachial ports are inserted with technical methods similar to those used for PICCs (i.e.,: ultrasound-guided puncture and cannulation of deep veins, use of microintroduction kits, ultrasound-based tip navigation, tip location using intracavitary ECG). In the past, brachial ports had mostly disappointing clinical results, since the veins were cannulated at the level of the antecubital fossa (as for the PICCs of the 20th century) and the reservoir was often pocketed in uncomfortable areas (forearm), sometimes by complex, not straigh tunneling. Today, the best insertion technique involves ultrasound guided cannulation of a deep vein at arm level (in the green zone or in the yellow zone according to Dawson) and the subsequent subcutaneous placement of the reservoir above the fascia of the biceps muscle. As with all ports (including chest ports), it is advisable to use a micro-introduction kit; ultrasound should be use not only to cannulare the vein but also to check the correct direction of the catheter (by ultrasound examination of the supraclavicular area, so to visualize the passage of the catheter through the subclavian vein into the brachio-cephalic vein); finally, it is mandatory touse an intra-procedural tip location method, preferably intracavitary ECG and/or echocardiography).
As for the material, reservoirs of appropriate size and very low profile (about 8mm) are used, connected with catheters - preferably in polyurethane - with a diameter between 4Fr and 5.5Fr. Polyurethane catheters are easier to insert than silicone ones, and they have a lower risk of tip migration (secondary malposition). As for the PICCs, the external diameter of the catheter must not exceed 1/3 of the internal diameter of the vein to be cannulated. The tip - as for the PICCs and the thoracic ports - will be positioned at the cavo-atrial junction.