Date of Surgery:
Pre-op Diagnosis: - Long Term Need for IV access
Post-op Diagnosis: Procedure: Same
Surgeon - Dr. Luk/Dr. Tran
Complication - None
Blood Loss - Minimal
Finding - Normal Anatomy
Anesthesia - General
Procedure:
1) centrally inserted tunnelled catheter with subcutaneous resevoir - i.e. port
2) intraoperative fluoroscopy
3) intraoperative ultrasound
Findings: normal anatomy
Complication: none
Patient comes in with the above diagnosis and was consented for the above procedures. Risks, benefits, and alternatives were discussed with patient, which includes, but are not limited to, postoperative or chronic pain, bleeding, wound infection, hematoma, collapsed lung, injury to other organs, or need for further procedures or workup. Other Complications may include deep vein thrombosis (blood clots), as well as other side effects affecting other organ systems such as the heart or lungs, and in rare circumstances, death as a result of the above complications. The patient understands and agrees to proceed with the proposed procedure.
The Patient was given preoperative antibiotics.
After consent was obtained, the patient was brought to the OR and underwent general anesthesia. The patient was prep and draped in the standard manner.
Timeout was performed and all was in agreement.
PROCEDURE: The patient was first placed in Trendelenburg position. Seldinger technique with help of intraoperative ultrasonography was used to access the patient's left internal jugular vein. The guide wire into the patient's central venous system. It is threaded down the needle and passed down the superior vena cava into the atrium. This was done under the supervision of intraoperative fluoroscopy. Once the wire was placed successfully, the insertion needle was removed. Local anesthetic was then used to perform a field block in the area below the left clavicle.
Next a #10 scalpel was used to create a subcutaneous pocket. The knife was used to make a skin incision roughly about 3.5 centimeters. The undermining of the subcutaneous tissue was created using the electrocautery. Once the pocket was large enough to fit the port, then the catheter itself was tunneled underneath the skin. It is tunneled from the subcutaneous pocket region toward the needle insertion site.
Next the dilator and sheath complex were placed over the wire. Then it was inserted again using a Seldinger technique under fluoroscopic guidance to identify and assure it is in proper position. Once it is, then the guide wire was removed. Next the dilator was removed leaving the sheath in the central vein. Next the catheter was then slid into the sheath, passed further down into the central venous system where the tip of the catheter was allowed to rest at the atrium superior vena cava complex. The opposite end of the wire was trimmed so that it would be able to fit onto the port at the subcutaneous pocket site. Finally, when this was achieved, again with the help of fluoroscopy, I tested the port by flushing and pulling back on it and there was good blood flow without any obstruction. The wound was then irrigated. The port was anchored into the pectoral fascia using 3-0 Prolene suture. All skin incisions were then closed using absorbable stitch.
At the end of the case, counts were carried out. Instrument, sponge, and needle counts were completed and reported to me as correct.
The patient overall tolerated the procedure well, was transferred to the recovery room in stable and satisfactory condition. A post-port placement x-ray will be obtained to evaluate for position as well as to evaluate for any complications.