Needle Insertion Difficulty Algorithm (NIDA): A novel pilot study to predict Huber needle insertion difficulty in totally implanted devices

Safeguarding of venous assets in cancer patients provides for positioning vascular devices. In totally implanted central venous access devices, hereinafter referred as TIVADs, it’s necessary introducing Huber needle, into subcutaneous port, to use it. This procedure is not easy for all implanted devices. The procedural difficulty is to be attributed both to the type of the implanted port and to the skill of the clinician. The degree of patient satisfaction is variable and related with the clinician performing the maneuver. It follows a professional dissatisfaction of the clinician and a hesitation of the patient. Moreover, the incorrect positioning of the Huber needle into the port, could lead to the infusion of antiblastic drugs into the subcutaneous tissue with the consequent tissue damage due to extravasation of the drugs. Evaluation of different characteristics of TIVADs, allowed grouping them, in different types, setting up the S.P.I.A. method (Subcutaneous Port Investigator Assessment). Collected data from medical records concerning: primary pathology, port’s permanence and using, Huber needle insertion failed events, if a vascular access expert/specialist clinician has been called, weight gain or loss were recruited. These data made it possible to determine the types of implanted ports that were most difficult to insert the Huber needle, creating the N.I.D.A. (Needle Inserting Difficulty Algorithm) as a prognostic index of Huber needle inserting into the port. In particular, the type of implanted port, that is, if it was a brachial or thoracic implant ( p < 0.001), the SPIA type, if type 1, 2, or 3 ( p < 0.001) and the experience of the clinician ( p < 0.001) were considered as predictors of a successful first attempt and then can perform the NIDA. The relevant aspects in the success of the procedure are therefore the type of port (thoracic or brachial), the SPIA type, and the experience of the clinician in the successful insertion of the Huber needle into the port at the first attempt.

Transanal irrigation systems for managing bowel dysfunction: a review

Transanal irrigation (TAI) is used to treat bowel dysfunction, including faecal incontinence and constipation, where physical exercises, dietary changes and/or medication alone are insufficient. During TAI, water is instilled via the anal canal into the distal colon, and the water expels the faecal contents via wash out and/or stimulating colonic peristalsis. This can reduce the severity and frequency of bowel dysfunction, hospitalisation rate, management time and treatment costs and promotes dignity, independence and quality of life. Different TAI systems are available that instil a low or high volume of water, through a balloon catheter or a cone, using a manual or electric pump or a gravity feed. Balloon catheters are secure, convenient and comfortable, while cone systems may be considered less invasive but require patient or carer dexterity to be held in place. Low-volume systems are compact and convenient, but high-volume systems achieve better results for some conditions. Gravity-fed systems need to be suspended above the user, while electric pumps may be cumbersome. Bed systems are designed for patients who are bedbound or require hoisting. The optimal system should be selected based on assessment, informed by clinical need and patient preference. Users must be assessed by a specialist clinician for contraindications, comorbidities and capacity to consent. The clinician should then provide selected patients with ongoing structured training and support to ensure safe and effective use.