POSTOPERATIVE
DIAGNOSIS: End stage renal disease.
OPERATION
PERFORMED: Insertion of left
IJ HemoSplit catheter with ultrasound and fluoroscopic guidance.
ANESTHESIA:
Local
sedation.
FINDINGS: Patent
left IJ. The tip of the catheter was in
the right atrium. There were no
complications.
PROCEDURE
IN DETAIL: A
74-year-old gentleman who had an infected catheter and now requires long-term
hemodialysis access. Consent was obtained. The patient was taken to the operating room
for insertion of a new catheter.
The patient was placed on the OR table in supine
position. The left side of the neck and
the anterior chest was prepped and draped in usual sterile manner. The ultrasound was used to visualize the left
internal jugular vein. Local anesthetic
was administered through the skin and subcutaneous tissue and the left IJ was
cannulated with 18-gauge needle. The
guidewire was inserted through the needle under fluoroscopy. The guidewire was _____ in the inferior vena
cava. An incision was made at the entry
site, and the catheter was tunneled through the subcutaneous tissue from the
anterior chest wall up into the neck. A
dilator with a peel-away introducer was threaded over the guidewire under
fluoroscopy. The guidewire and the
dilator were removed leaving the peel-away introducer in place. The catheter was then threaded through the
peel-away introducer and the introducer was peeled away and removed leaving the
catheter in place. The tip was adjusted
to be in the right atrium. Both ports
were aspirated and flushed without any difficulty and then capped with 2500
units of Heparin and 2 mL in each port.
The incision at the base of the neck was reapproximated with running 4-0
Monocryl subcuticular stitch. The
catheter was secured to the skin with 4-0 Monocryl suture. Sterile dressings were applied and this
terminated the procedure. There was no complication.
Great post. I had no idea you could have an infected catheter. Poor man. This was very interesting, thanks so much for sharing.
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