Right subclavian Port-A-Cath placement Operative fluoroscopy with image acquisition and supervision Foley cath/heparin

PREOPERATIVE DIAGNOSES:

1.  Uterine cancer.

2.  Advanced stage malignancy.

3.  Chemotherapy.

4.  Venous access.

POSTOPERATIVE DIAGNOSES:

1.  Uterine cancer.

2.  Advanced stage malignancy.

3.  Chemotherapy.

4.  Venous access.

PROCEDURE PERFORMED:

1.  Right subclavian Port-A-Cath placement.

2.  Operative fluoroscopy with image acquisition and supervision.

3.  Foley cath/heparin.

COMPLICATIONS:                                     None.

ESTIMATED BLOOD LOSS:                    Less than 30 mL.

DISPOSITION:                                             The patient was transferred to the recovery room in stable condition.

JUSTIFICATION:                                        The patient presents on 04/24/09 to the above procedures, for the above diagnoses.  She is aware that these risks include infection, bleeding, injury to adjacent structures such as the regional blood supply, pulmonary structures.  All of the patient's questions have been answered, apparently to her satisfaction.  The patient has elected to proceed with surgery, and is medically cleared.

PROCEDURE IN DETAIL:                                    Following documentation of informed consent for the above procedures, the patient was brought to the operative suite where she was administered general, conscious sedation, prepped and draped in the usual sterile fashion in the supine position.  Subclavian Port-A-Cath placement _____ with a single pass on the right side, the subclavian vein is accessed.  A wire is advanced to the region of the superior vena cava under fluoroscopic guidance.  Using fluoroscopic image acquisition and supervision, a catheter was advanced to the region of the superior vena cava.  A 2-cm incision was developed 2 fingerbreadth below and parallel to the clavicle on the right side, where a pocket is developed in the subcutaneous to accommodate the port.  The port is secured in the chest wall fascia using 2 interrupted sutures of 2-0 Prolene.  The subcutaneous was irrigated and closed using a running suture of 2-0 Vicryl.  A 4-0 Monocryl was used to reapproximate skin margins.  _____ upon completion is notable for good venous return and flow.  Fluoroscopic assessment is notable for appropriate line placement.  The port is generously flushed with heparinized solution.  Dressings were applied.  All sponge and needle counts were correct x3 at the end of the case.  The patient tolerated these procedures well, and was transferred to the recovery room in stable condition.