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 8F

 

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 Internal Jugular Vein was documented with ultrasound and images saved to PACS.

4.     RN was monitoring vital signs throughout.  Sponge and needle counts were performed.

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.  An image of the needle entering the vein was saved to PACs. 

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 Heparin / ml).

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

17.  Port pocket was closed using a dual layer technique.  Sponge and needle counts were reconciled, with the counts being correct.

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 Right Internal Jugular Vein 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.  

 

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

 

Permacath (Tunneled Cuffed Dialysis Catheter) Placement

 

Date of procedure:

[ ]

 

Indication:

Venous access for dialysis

 

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):

16F Bard Hemosplit XK long term dialysis catheter [19 cm]

 

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 Internal Jugular Vein 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 and tunnel tract.

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

9.     After a series of exchanges, an 80 cm Amplatz wire was advanced to the IVC.

10.  The dialysis catheter was tunneled from a site approx. 2 cm below the clavicle to the venotomy site.

11.  The venotomy site was serially dilated using the provided dilators.

12.  A peel away sheath was placed over the Amplatz under intermittent fluoroscopic guidance.

13.  The inner dilator and wire were removed and the dialysis catheter was advanced through the sheath.

14.  The sheath was peeled away.

15.  Both lumens of the catheter aspirated and flushed easily, and were locked with 1000 U / ml of heparin solution.

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

17.  The catheter was secured with silk sutures.

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 Permacath, as above.

 

Plan or Recommendations:

Successful placement of a R IJV approach 16F Permacath (tunneled cuffed dialysis catheter).  The catheter is ready for use.  Note that the catheter hubs are locked with 1000 U / ml of heparin solution.  

 

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

 

Hickman (Tunneled Cuffed Pheresis Catheter) Placement

 

Date of procedure:

[ ]

 

Indication:

Venous access for pheresis treatment.

 

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):

12F Hickman Trifusion Catheter [19 cm]

 

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 Internal Jugular Vein 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 and tunnel tract.

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

9.     After a series of exchanges, an 80 cm Amplatz wire was advanced to the IVC.

10.  The pheresis catheter was tunneled from a site approx. 2 cm below the clavicle to the venotomy site.

11.  The venotomy site was serially dilated using the provided dilators.

12.  A peel away sheath was placed over the Amplatz under intermittent fluoroscopic guidance.

13.  The inner dilator and wire were removed and the pheresis catheter was advanced through the sheath.

14.  The sheath was peeled away.

15.  Both lumens of the catheter aspirated and flushed easily, and were locked with 100 U / ml of heparin solution.

16.  Final image of the Hickman catheter in situ was stored.

17.  The catheter was secured with silk sutures.

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 Hickman catheter, as above.

 

Plan or Recommendations:

Successful placement of a RIJV approach Hickman catheter (tunneled cuffed pheresis catheter).  The catheter is ready for use.  Note that the catheter hubs are locked with 100 U / ml of heparin solution.  

 

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

 

Examination

PICC line placement.

 

Clinical History

[ ]

 

Technique

Operators:

Sarel Gaur MD

 

Medications:

Lidocaine at site.
No IV medications.

 

Contrast:

N/A

 

Fluoro time:

[ ] minutes

 

Access site(s):

[Right Basilic Vein]

 

Device(s):

BioFlo PICC 4F Single Lumen [39] cm

 

Complications:

None

 

Procedure:

 

1.     Informed Consent was obtained.

2.     Patient was brought to the IR suite and placed supine on the table; the [right] arm was placed on an armboard.

3.     RN was monitoring vital signs throughout.

4.     A patent [Right Basilic Vein] was documented with ultrasound and images saved to PACS.

5.     [Right] upper arm epidermis was sterilized with chlorhexidine 2%

6.     Lidocaine was used to anesthetize the presumed access site on the [Right] upper arm.

7.     Under constant ultrasound guidance, access to the [right basilic vein] was obtained using micropuncture technique.

8.     Through the micropuncture needle, a core mandril wire was advanced to the SVC. 

9.     A 5.5 F peel away sheath was advanced over the wire

10.  The wire was clamped and used to measure the PICC device.

11.  The catheter was placed through the peel-away sheath until the tip was in the SVC. An image was stored.

12.  Peel-away sheath was removed.

13.  The PICC aspirated and flushed easily

14.  An image of the PICC access site was stored.

15.  The PICC was secured with Statlock device and biopatch placed. A sterile tegaderm was placed on the device.

16.  The patient was transported back to the holding area.

Maximal Sterile Barrier Technique was used during CVC Insertion including: 

Cap, mask, sterile gown, gloves, large sterile sheet, hand scrub, 2 % chlorhexidine for epidermal antisepsis

 

Comparison

Plain film dated 10/1/2015.

 

Findings

Patent Right Basilic Vein. Placement of a [Right Arm Picc], tip in the SVC. No retained radiopaque foreign body at the insertion site.

 

Impression

Sucessful placement of a [right arm 39] cm BioFlo PICC 4F [single lumen]. Catheter is ready for 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):

[Right] 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 and the catheter were removed.

3.     Pressure was held at the venotomy site to achieve hemostasis.

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.  Sponge and needle counts were performed with counts being correct.

7.     Sterile dressing was placed.

8.     The procedure was terminated.

 

Impression:

Successful removal of a Right Internal Jugular Vein approach Portacath in its entirety.

 

Plan or Recommendations:

Dressing management.  

 

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

 

Procedure:

Permacath removal

 

Date of procedure:

[ ]

 

Indication:

D/C Permacath.

 

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] Upper Anterior Chest

 

Device(s):

Tunneled Cuffed Dialysis Catheter

 

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 and following local lidocaine infusion, the catheter was separated from the subcutaneous tissues using a Kelly clamp and the entire device removed.

3.     Pressure was held at the venotomy site to achieve hemostasis.

4.     Sterile dressing was placed.

5.     Procedure Terminated.

 

Impression:

Successful removal of a Right Internal Jugular Vein approach Permacath in its entirety.  No retained radiopaque foreign body.

 

Plan or Recommendations:

Dressing management.  

 

 

Quinton (non tunneled dual lumen Hemodialysis/ Pheresis Catheter) Placement

 

Date of procedure:

[ ]

 

Indication:

Venous access for dialysis and / or pheresis

 

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):

12F Niagara Temporary Dialysis Catheter, 2 - lumen

 

Complications:

None

 

Technique and Findings:

 

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

2.    A patent right IJV was documented with ultrasound and images saved to PACS.

3.    RN was monitoring vital signs throughout.

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

5.    IV Sedation was administered.

6.    Lidocaine was used to anesthetize the region of the venotomy.

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

8.    After a series of exchanges, an Amplatz wire was advanced to the lower SVC.

9.    The included dilator was used to dilate the subcu tract.

10.  The 12 French dual-lumen Temporary Dialysis catheter was advanced over the wire until the tip was in the SVC. This was confirmed fluoroscopically.

11.  Both lumens of the catheter aspirated and flushed easily.

12.  The catheter was secured with silk sutures.

13.  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 Quinton Catheter.

 

Plan or Recommendations:

Successful placement of a Right Internal Jugular Vein approach 12F nontunnelled dual lumen hemodialysis Catheter (Quinton).  The catheter is ready to use.