PREOPERATIVE DIAGNOSES: 1. Hemodialysis-dependant end-stage renal disease.
2. Nonfunctioning right Opti-Flow hemodialysis catheter.
POSTOPERATIVE DIAGNOSES: 1. Hemodialysis-dependant end-stage renal disease.
2. Nonfunctioning right Opti-Flow hemodialysis catheter.
PROCEDURE: 1. Removal of right Opti-Flow hemodialysis catheter.
2. Insertion of Tesio hemodialysis catheter via the left internal jugular vein.
ESTIMATED BLOOD LOSS: 5 mL.
INDICATIONS: The patient is a 58-year-old gentleman who has end-stage renal disease on hemodialysis. He had an Opti-Flow catheter placed approximately a year and a half ago. For the past five months or so, he has not been going through dialysis. He was admitted two days ago with a BUN of 180 and creatinine of 25. The Opti-Flow catheter could not be flushed or blood could not be withdrawn. Yesterday I inserted a Quinton catheter via the right femoral vein. I was asked to insert a Tesio catheter for long-term hemodialysis. The indications, risks, and benefits of the procedure were explained to the patient and to his wife. He consented to the operation. He also consented for removal of the right Opti-Flow hemodialysis catheter.
PROCEDURE IN DETAIL: A time-out was performed prior to start of the operation. The patient was correctly identified as well as the procedure. With the patient under general anesthesia with an LMA, the patient’s upper chest and neck were prepped with dura prep and draped sterilely. The cuff securing the Opti-Flow catheter was dissected out from the subcutaneous tissues with blunt dissection and with the electrocautery. The Opti-Flow catheter was then easily withdrawn intact. Pressure was applied on the right internal jugular vein, which was the insertion site. The patient was placed in Trendelenburg. The left internal jugular vein was accessed with a 22-gauge finder needle. The first attempt with the 18-gauge introducer needle accessed the left carotid artery and the needle was removed and pressure was applied. The left internal jugular vein was then accessed and guidewire threaded and the needle removed. The left internal jugular vein was accessed the second time, and second guidewire threaded. Fluoroscopy was used to confirm correct position of the guidewires. The patient was taken out from Trendelenburg.
A 0.5-cm incision was made at the left anterior chest wall. The left internal jugular vein skin access sites were enlarged with an #11 scalpel blade. The tunnelers were used to connect these two sites and the two Tesio catheters were tunnelled. The introducer and dilator were advanced over one of the guidewires. The venous catheter was threaded through the introducer and the peel-away sheath removed. This was done under fluoroscopic guidance. This procedure was repeated for the arterial catheter. Fluoroscopy was used to confirm correct positioning of the catheters. The catheters were cut proximally and the connecter was applied. The catheters were flushed with dilute heparin solution and then with the concentrated final heparin solution. The tiny incisions were closed with a single 3-0 Vicryl subcuticular suture and Dermabond was applied. The catheters were sutured also with the enclosed clasps.
After the catheters were in place, the patient’s oxygen saturation suddenly decreased into the 80s and his blood pressure dropped. The anesthesiologist treated this with pressors. Over short period of time, the pressure improved as did the oxygen saturations to run 96%. A stat portable chest x-ray was performed in the Operating Room, which did not show any evidence of a pneumothorax or pleural effusion. The catheters were in good position.
The patient tolerated the procedure well and there were no complications. The patient was x-rayed in the Operating Room and transported to the Post Anesthesia Care Unit in stable condition.
2. Nonfunctioning right Opti-Flow hemodialysis catheter.
POSTOPERATIVE DIAGNOSES: 1. Hemodialysis-dependant end-stage renal disease.
2. Nonfunctioning right Opti-Flow hemodialysis catheter.
PROCEDURE: 1. Removal of right Opti-Flow hemodialysis catheter.
2. Insertion of Tesio hemodialysis catheter via the left internal jugular vein.
ESTIMATED BLOOD LOSS: 5 mL.
INDICATIONS: The patient is a 58-year-old gentleman who has end-stage renal disease on hemodialysis. He had an Opti-Flow catheter placed approximately a year and a half ago. For the past five months or so, he has not been going through dialysis. He was admitted two days ago with a BUN of 180 and creatinine of 25. The Opti-Flow catheter could not be flushed or blood could not be withdrawn. Yesterday I inserted a Quinton catheter via the right femoral vein. I was asked to insert a Tesio catheter for long-term hemodialysis. The indications, risks, and benefits of the procedure were explained to the patient and to his wife. He consented to the operation. He also consented for removal of the right Opti-Flow hemodialysis catheter.
PROCEDURE IN DETAIL: A time-out was performed prior to start of the operation. The patient was correctly identified as well as the procedure. With the patient under general anesthesia with an LMA, the patient’s upper chest and neck were prepped with dura prep and draped sterilely. The cuff securing the Opti-Flow catheter was dissected out from the subcutaneous tissues with blunt dissection and with the electrocautery. The Opti-Flow catheter was then easily withdrawn intact. Pressure was applied on the right internal jugular vein, which was the insertion site. The patient was placed in Trendelenburg. The left internal jugular vein was accessed with a 22-gauge finder needle. The first attempt with the 18-gauge introducer needle accessed the left carotid artery and the needle was removed and pressure was applied. The left internal jugular vein was then accessed and guidewire threaded and the needle removed. The left internal jugular vein was accessed the second time, and second guidewire threaded. Fluoroscopy was used to confirm correct position of the guidewires. The patient was taken out from Trendelenburg.
A 0.5-cm incision was made at the left anterior chest wall. The left internal jugular vein skin access sites were enlarged with an #11 scalpel blade. The tunnelers were used to connect these two sites and the two Tesio catheters were tunnelled. The introducer and dilator were advanced over one of the guidewires. The venous catheter was threaded through the introducer and the peel-away sheath removed. This was done under fluoroscopic guidance. This procedure was repeated for the arterial catheter. Fluoroscopy was used to confirm correct positioning of the catheters. The catheters were cut proximally and the connecter was applied. The catheters were flushed with dilute heparin solution and then with the concentrated final heparin solution. The tiny incisions were closed with a single 3-0 Vicryl subcuticular suture and Dermabond was applied. The catheters were sutured also with the enclosed clasps.
After the catheters were in place, the patient’s oxygen saturation suddenly decreased into the 80s and his blood pressure dropped. The anesthesiologist treated this with pressors. Over short period of time, the pressure improved as did the oxygen saturations to run 96%. A stat portable chest x-ray was performed in the Operating Room, which did not show any evidence of a pneumothorax or pleural effusion. The catheters were in good position.
The patient tolerated the procedure well and there were no complications. The patient was x-rayed in the Operating Room and transported to the Post Anesthesia Care Unit in stable condition.
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