The SaRePo protocol: A seven-step strategy to minimize complications potentially related to the removal of totally implanted central venous access devices

Removal of totally implanted central venous access devices (brachial ports, chest-ports, femoral ports) is potentially associated with the risk of untoward events, some of them negligible (prolonged maneuver time due to technical difficulties), some relevant (hematoma), and some severe (embolization of catheter fragments into the circulation). The removal technique suitable for minimizing such complications has been described only in few manuals, but it has never been standardized. This paper describes a standardized protocol (SaRePo: Safe Removal of Ports) which consists of seven basic strategies to be adopted systematically during removal of totally implanted venous access devices, so to minimize the risk of adverse events. These strategies include: evaluation of the patient's history, preprocedural ultrasound scan of the veins, appropriate aseptic technique, proper local anesthesia, catheter extraction, removal of the reservoir from the pocket, closure of the surgical incision.