Introduction

Vascular access care is increasingly delivered through multidisciplinary teams, with nurse-led practice well established in PICC insertion and management.
PICC-PORT implantation represents a potential expansion of advanced nursing practice; however, evidence on the feasibility of this transition remains limited.

Aim

To evaluate the feasibility of expanding nurse-led practice to include PICC-PORT implantation in a PICC-experienced team through a structured clinical pathway.

Setting

The study was conducted within a dedicated vascular access outpatient clinic at CRO di Aviano, an oncology referral center, providing centralized insertion, management, and follow-up of vascular access devices.  

Methods

A structured implementation pathway was introduced in a dedicated vascular access clinic, involving PICC-experienced nurses and incorporating competency-based training, standardized protocols and integrated follow-up.
The implementation pathway is summarized in the flowchart, highlighting the key steps from existing PICC expertise to PICC-PORT implantation

◊ PICC Expertise
       ❖ Aseptic technique
       ❖ US-guided venipuncture
       ❖ Tunneling
       ❖ Tip Navigation and Location (IC-ECG or US-Bubble Test)
       ❖ Management

◊ Structured Training
       ❖ Hands-on supervised procedure
       ❖ Subcutaneous pocket creation
       ❖ Reservoir placement and management

◊ Standardized Protocol
       ❖ Patient selection criteria
       ❖ Standard Operating Procedures
       ❖ SIP-Port protocol
       ❖ Procedural checklist

◊ Integrated Follow Up
       ❖ Dedicated clinic
       ❖ Patient accessibility
       ❖ Complications management
       ❖ Continuity of care

Results

150 PICC-PORTs were implanted over a 6-month period with 100% procedural success. No increase in overall or severe complications was observed during early follow-up.
Reported complications were consistent with those expected for device implantation and underlying oncological disease, including minor hematomas and occasional catheter-related thrombotic events, managed with appropriate antithrombotic therapy. No infectious events, severe complications, or malfunctions of the inserted vascular devices were reported. 

Conclusion
A step-up model within a group of nurses experienced in PICC insertion is feasible with a structured implementation pathway. Nurse-led PICC-PORT implantation is feasible and safe when supported by structured training and standardized procedures.