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A Comparison of 2 Venous Puncture Sites for Peripheral Implanted Ports

Katsoulas, Theodoros PhD, MSc, RN; Kapritsou, Maria PhD, MSc, RN; Alexandrou, Evan PhD, MPH, RN, ICU Cert; Bastaki, Maria PhD, MSc, RN; Giannakopoulou, Margarita PhD, BSc, RN; Kiekkas, Panagiotis PhD, MSc, RN; Stafylarakis, Emmanouil MSc, BSc, RN; Konstantinou, Evangelos A. PhD, MSc, BSN, RN

doi: 10.1097/NAN.0000000000000344
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The use of peripheral implanted ports to administer parenteral nutrition in a number of patient cohorts is increasingly seen as a safe alternative to chest ports with equivalence in long-term outcomes. Two insertion sites on the upper arm were compared using the zone insertion method (ZIM), which was developed as an approach to optimize and reduce catheter-related exit site complications. The ZIM divides the medial upper arm into 3 main colors, red, green, and yellow, which are based on musculoskeletal, skin, and vessel characteristics. The optimal exit site is considered to be the green zone, the middle third of the upper arm. Thirty-five patients were allocated to vein puncture at the yellow/green zone (group A) and 35 patients at the yellow zone near the axilla (group B). All devices were implanted in the distal green zone. Successful peripheral port implantation was 91.4% (n = 35) for group A and 100.0% (n = 35) for group B (P = .07). No procedural or postprocedural complications were observed.

National and Kapodistrian University of Athens, Athens, Greece (Drs Katsoulas, Giannakopoulou, and Konstantinou and Mr Stafylarakis); Day Care Surgery “N. Kourkoulos,” Hellenic Anticancer Institute, “Saint Savvas” Hospital, Athens, Greece (Dr Kapritsou); Liverpool Hospital, South Western Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia; School of Nursing and Midwifery at the Western Sydney University, Sydney, New South Wales, Australia; and Alliance for Vascular Access Teaching and Research Group (AVATAR) at Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia (Dr Alexandrou); General Hospital of Nikaias, Piraeus, Greece (Dr Bastaki); University of Patras, Patras, Greece (Dr Kiekkas); Agioi Anargiroi Oncology Hospital, Athens, Greece (Dr Konstantinou).

Theodoros Katsoulas, PhD, MSc, RN, is an assistant professor of critical care nursing at the National and Kapodistrian University of Athens, head of the research unit of the university intensive care unit, and member of the vascular access laboratory at the General Oncology Hospital of Kifissia in Athens, Greece. He holds an MSc in nursing and a PhD in clinical nursing. Dr Katsoulas has published 38 articles in national and international peer-reviewed journals, more than 80 abstracts at national and international conferences, and 41 book chapters. He is also a coeditor of 7 books on critical care nursing. Dr Katsoulas has received 9 awards and commendations at national conferences. His research interests include emergency and critical care nursing and vascular access.

Maria Kapritsou, PhD, MSc, RN, is chief nurse of the postanesthesia care unit at the Day Care Surgery “N. Kourkoulos,” Hellenic-Anticancer Institute, Saint Savvas Hospital, in Athens, Greece. She holds a PhD in oncology surgical nursing, an MSc in surgical nursing, and is currently pursuing a master's degree in health management. She has experience in research methodology (quantitative and laboratory assays) and has a strong interest in clinical nursing practice and research focused on pain, stress, and neuropeptide level issues, predominantly in oncology and surgical adult patients. She has published more than 30 articles in international peer-reviewed journals.

Evan Alexandrou, PhD, MPH, RN, ICU Cert, is a clinical nurse consultant in the intensive care unit at Liverpool Hospital in South Western Sydney, New South Wales, Australia, where he coordinates the central venous access service. Dr Alexandrou is involved in clinical education at an undergraduate and postgraduate level for nursing and medical training programs and is a conjoint lecturer with the faculty of medicine at the University of New South Wales, a senior lecturer with the School of Nursing and Midwifery at Western Sydney University, and an adjunct associate professor with the Alliance for Vascular Access Teaching and Research Group based in the Menzies Health Institute at Griffith University in Queensland, Australia.

Maria Bastaki, PhD, MSc, RN, holds a BSc in nursing, an MSc in health management, and a PhD in perianesthesia nursing. She has 13 years of clinical experience in anesthesiology. She has presented research at 20 Hellenic and international conferences and published 7 articles in peer-reviewed journals.

Margarita Giannakopoulou, PhD, BSc, RN, is a faculty member in the department of nursing at the National and Kapodistrian University of Athens, Greece, and director of the clinical nursing applications laboratory at the General Oncology Hospital of Kifissia in Athens, Greece. She holds a BSc in nursing and a PhD in neuroscience. She is associate editor of the peer-reviewed Hellenic Journal of Nursing and an editorial board member of the Nursing Care and Research journal. Dr Giannakopoulou has published more than 110 articles in national and international peer-reviewed journals. Her research interests include clinical nursing practice issues with a focus on pain, stress, and neuropeptide research in critical care patients.

Panagiotis Kiekkas, PhD, MSc, RN, is an associate professor in the nursing department at the University of Patras in Patras, Greece. He has authored or coauthored 58 articles in scholarly journals, as well as 12 book chapters. He holds a PhD in critical care nursing and an MSc in clinical nursing. His research interest is primarily in perianesthesia nursing.

Emmanouil Stafylarakis, MSc, BSc, RN, is currently a senior theatre registered nurse at the Queen Elizabeth Hospital of the Lewisham and Greenwich National Health Service Trust in London, England. He holds a BSc (Hons) in nursing and an MSc in transcultural nursing. His is pursuing a master's degree in perioperative medicine at University College London. He has collaborated with colleagues at the National and Kapodistrian University of Athens, researching minimal invasive vascular access regarding lumen and port peripherally inserted central catheters.

Evangelos A. Konstantinou, PhD, MSc, BSN, RN, is a professor of nurse anesthesiology and vascular access at Faculty of Nursing at National and Kapodistrian University of Athens. He has more than 70 publications in indexed journals and he is also the head of the Vascular Access Laboratory at Agioi Anargiroi Oncology Hospital. His clinical activities include insertion of vascular access devices such as PICCs, PICC Ports, CICC Ports, and dialysis catheters.

Corresponding Author: Maria Kapritsou, PhD, MSc, RN, Hellenic Anticancer Institute, “Saint Savvas” Hospital, Sapfous 2 Kallithea, Athens, Greece 17676 (mariakaprit@gmail.com).

Evan Alexandrou received unrestricted investigator-initiated research grants from product manufacturers Becton-Dickinson, Cook Medical, B Braun, and 3M. All funds were made payable to either Western Sydney University or Griffith University in Australia and not to the individual. The other authors of this article have no conflicts of interest to disclose.

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