Procedure:

Portacath Placement

 

Date of procedure:

[ ]

 

Indication:

Venous access for chemotherapy

 

Operators:

Sarel Gaur MD

 

Medications:

Versed IV:  [ ] ml total

Fentanyl IV:  [ ] ml total

 

Contrast:

[ ] ml of Omnipaque intravenous

 

Fluoro time:

[ ] minutes

 

Access site(s):

Right Internal Jugular Vein

 

Device(s):

Bard PowerPort

 

Complications:

None

 

Technique and Findings:

 

1. Informed Consent was obtained.

2. Patient was brought to the IR suite and placed supine on the table.

3. A patent Right IJV was documented with ultrasound and images saved to PACS.

4. RN was monitoring vital signs throughout.

5. Right neck and upper chest epidermis was sterilized with chlorhexidine 2%.

6. IV Sedation was administered.

7. Lidocaine with and without epinephrine was used to anesthetize the region of the venotomy, tunnel tract, and port pocket site.

8. Under constant ultrasound guidance, access to the right internal jugular vein was obtained using micropuncture technique.

9. Port pocket was created using a combination of sharp and blunt dissection.

10. A single-lumen port catheter was tunneled from the pocket to the venotomy site.

11. Venotomy was up sized and a peel-away sheath was placed over an Amplatz wire.

12. The port catheter was placed through the peel-away and length adjusted.

13. The catheter was trimmed to the appropriate length and port was attached then placed in the pocket.

14. Peel-away sheath was removed.

15. The port aspirated and flushed easily, and was locked with dilute heparin flush (100 U/ml).

16. Final image of the portacath in situ was stored.

17. Port pocket was closed using a dual layer technique.

18. Sterile dressings were applied and the patient was sent back to the holding area.

Maximal Sterile Barrier Technique was used during CVC Insertion including:  Cap/mask/sterile gown/gloves/large sterile sheet. Hand hygiene/2 % chlorhexidine for cutaneous antisepsis

 

Impression:

Successful placement of a RIJV Portacath, as above.

 

Plan or Recommendations:

Portacath is ready for use.  The port should be locked with 10 cc of dilute heparin when not in use.  

 

---------------

Procedure:

Portacath removal

 

Date of procedure:

[ ]

 

Indication:

D/C Port.

 

Operators:

Sarel Gaur MD

 

Medications:

Versed IV:  [ ] ml total

Fentanyl IV:  [ ] ml total

 

Contrast:

[ ] ml of Omnipaque intravenous

 

Fluoro time:

[ ] minutes

 

Access site(s):

[Left] Upper Anterior Chest

 

Device(s):

Bard Power Port

 

Complications:

None

 

Technique and Findings:

 

1. A dedicated procedure nurse monitored the patient throughout the procedure. 

2. Following sterile preparation and draping using standard aseptic technique following local lidocaine infusion the port site was opened with the scalpel and following blunt and sharp dissection the port

3. and the catheter were removed.

4. Spot fluoroscopic images were obtained before and after the procedure to document removal.

5. No purulent material was seen in the chest port pocket.

6. The pocket was then sutured in 2 stages using 2-0 Vicryl subcutaneous and 4-0 Vicryl subcuticular.   

7. Sterile dressing was placed.

8. Procedure Terminated.

 

Impression:

Successful removal of a RIJV Portacath in its entirety.

 

Plan or Recommendations:

Dressing management.  

 

------------------------

Procedure:

Tunneled Pleural Catheter Placement / Aspira Placement / PleurX Placement

 

Date of procedure:

[ ]

 

Indication:

Malignant Pleural Effusion for long term drainage and palliation

 

Operators:

Sarel Gaur MD

 

Medications:

Versed IV:  [ ] ml total

Fentanyl IV:  [ ] ml total

 

Contrast:

[ ] ml of Omnipaque intravenous

 

Fluoro time:

[ ] minutes

 

Access site(s):

[Left] anterolateral thorax

 

Device(s):

Aspira Drainage Catheter

 

Complications:

None

 

Technique and Findings:

 

1. The procedure, possible complications, and use of conscious sedation was explained to the patient patient's family and informed consent was obtained.

2. The patient was brought to the fluoroscopic suite and placed in the supine position with [left] side elevated on the fluoroscopic table. 

3. Nurse monitoring was performed throughout the entire procedure. 

4. Under continuous ultrasound guidance an 18 gauge needle was percutaneously  advanced into the left anterio-lateral chest.

5. Under fluoroscopic guidance a J-wire was then advanced into the left pleural cavity.

6. After dilating the access site, a tunneling device was then used to tunnel a tract anteriorly through which a 16 French Aspira pleural catheter was pulled through.

7. A peel-away sheath was advanced over the wire and into the left pleural cavity.

8. After the wire was removed the catheter was then advanced through the peel-away sheath and into the left pleural cavity.

9. The external end of the catheter was then connected to low suction and [1500] cc of [serosanguineous] fluid was drained.

10. The catheter was then secured with 0-0 Ethilon suture material.

11. A sterile dressing was applied and the patient was transported back to the floor in stable condition.   

 

Impression:

Successful placement of a left tunnneld cuffed pleural catheter, as above.

 

Plan or Recommendations:

Pleural catheter is ready for use.  

 

------------------

Procedure:

Thoracentesis / Pleural Aspiration

 

Date of procedure:

[ ]

 

Indication:

Pleural Effusion for drainage

 

Operators:

Sarel Gaur MD

 

Medications:

Versed IV:  [ ] ml total

Fentanyl IV:  [ ] ml total

 

Contrast:

[ ] ml of Omnipaque intravenous

 

Fluoro time:

[ ] minutes

 

Access site(s):

[Left] posterolateral thorax

 

Device(s):

6 French Safety Centesis Catheter System

 

Complications:

None

 

Technique and Findings:

 

1. Limited ultrasound of the left chest was performed localization purposes.

2. The ultrasound demonstrated a [moderate left effusion. ]

3. A hard copy image was stored in the patient's records.

4. Following sterile preparation and draping using standard aseptic technique after local lidocaine infusion, the 6 French safety centesis pigtail was inserted into the left effusion.

5. Removal of approximately [1000 cc] of [serous] fluid.

6. All instruments were removed.

7. Sterile dressing was placed.

 

Impression:

Successful aspiration of the left pleural cavity, as above.

 

Plan or Recommendations:

Removal of [ ] cc of fluid.

Care as per primary team.  

 

------------

Procedure:

Pleural Drainage Catheter Placement / Chest Tube Placement

 

Date of procedure:

[ ]

 

Indication:

Pleural Effusion for drainage

 

Operators:

Sarel Gaur MD

 

Medications:

Versed IV:  [ ] ml total

Fentanyl IV:  [ ] ml total

 

Contrast:

[ ] ml of Omnipaque intravenous

 

Fluoro time:

[ ] minutes

 

Access site(s):

[Left] posterolateral thorax

 

Device(s):

8 French Cook Multipurpose Drainage Catheter

 

Complications:

None

 

Technique and Findings:

 

1. Risks, benefits, and alternatives were discussed and written consent was obtained. 

2. She was brought to examination room, seated in the stretcher.

3. [Left] pleural effusion was identified under ultrasound. 

4. Skin was marked, prepped with 2 percent chlorhexidine solution and draped.

5. 1 percent lidocaine provided local anesthesia.

6. Under constant ultrasound guidance, an 8 French multi purpose locking loop catheter was advanced into the pleural effusion using trocar technique

7. Sample of fluid was aspirated and sent to the laboratory for analysis.

8. Pleural drain was attached to a pleurEvac set to suction.

9. During thoracentesis, catheter was secured to the skin using 0 silk suture and a sterile airtight dressing was placed. 

10. When thoracentesis was complete, suction was detached, pleurevac placed to water seal. 

11. Procedure was terminated

 

Impression:

Successful placement of a pleural drainage catheter to the left pleural cavity, as above.

 

Plan or Recommendations:

Catheter and dressing care.

Will remove catheter when no longer needed.