Procedure: Ultrasound & fluoro guided right IJ tunneled, non-cuffed catheter
Indication:
Date:
Operators: Drs.
Access Site: Right internal jugular with ultrasound
Medications: mg IV Versed, mcg IV fentanyl, & 1 gram IV Ancef
Catheter: 5F single/double lumen, cm PICC
Fluoroscopy time: minutes
Complications: None immediate.
Technique:
The risks, benefits, and alternatives to the procedure and sedation were explained to the patient. Written informed consent was obtained. A timeout was performed.
The right jugular region was prepped and draped in sterile fashion. The region was ultrasonographically evaluated. Using local anesthetic and ultrasound guidance, the right internal jugular vein was punctured with a 21 gauge needle. An image documenting vein patency and needle entry was saved and stored to PACS.
A 0.018” wire was passed centrally and the needle exchanged for a 5 French transitional dilator. The wire was used to determine catheter length. The catheter was cut to length.
The soft tissues caudal and lateral to the sheath entry site were anesthetized with lidocaine with epinephrine. A dermatotomy was made and a tunneling tool used to pull the catheter through to the venotomy.
The dilator at the venotomy was replaced with a peel-away sheath.
During suspended respiration, the catheter was advanced through the peel-away and positioned centrally using fluoroscopy. The peel-away was removed and hemostasis achieved with manual compression. The catheter was aspirated, flushed, and heparinized per protocol.
The venotomy was closed with Dermabond and Steri-Strips applied. The hub was sutured in place with Ethilon. An antimicrobial disc and sterile dressing were applied.
The procedure was well tolerated, and the patient was discharged in satisfactory condition.
Findings:
- The right internal jugular vein is ultrasonographically patent and normal. Needle entry was documented. Images were stored to PACS.
- The newly placed catheter has a smooth course with the tip terminating in the right atrium.
- additional findings on images.
Impression:
Uneventful image guided placement of right internal jugular tunneled, non- cuffed central venous catheter as described.
Frequently Asked Questions
What is a tunneled non-cuffed PICC catheter?
A tunneled non-cuffed Peripherally Inserted Central Catheter (PICC) is a type of central venous catheter placed through a vein in the neck, specifically the internal jugular vein. Unlike cuffed catheters, non-cuffed ones do not have a small ring (cuff) under the skin to hold the catheter in place. They are often used for short to medium-term intravenous access for medications or nutrition.
Why is ultrasound used in PICC catheter placement?
Ultrasound is used in PICC catheter placement to visualize the vein and surrounding structures, ensuring accurate needle insertion and reducing the risk of complications. It helps the physician confirm vein patency, guide the needle into the vein, and minimize injury to nearby arteries and nerves. This technique enhances the safety and success rate of the procedure.
How is a PICC catheter secured in place?
After the PICC catheter is correctly positioned, it is secured using a combination of sutures and a sterile dressing. The hub of the catheter is sutured in place with a type of surgical thread called Ethilon. Additionally, an antimicrobial disc and sterile dressing are applied to prevent infections and ensure the catheter remains in position.
What medications are used during PICC catheter placement?
During PICC catheter placement, medications such as Versed (for sedation), fentanyl (for pain relief), and Ancef (an antibiotic) may be administered intravenously. These medications help keep the patient comfortable, manage pain, and prevent infections during and after the procedure.
What are the potential complications of PICC catheter placement?
Complications from PICC catheter placement are rare but can include bleeding, infection, or injury to nearby structures. The use of ultrasound guidance significantly reduces these risks. In this particular procedure, no immediate complications were noted, indicating a successful and uneventful placement.
What is the role of fluoroscopy in catheter placement?
Fluoroscopy provides real-time X-ray imaging to guide the placement of the catheter within the central veins. It ensures that the catheter is positioned correctly and safely within the body, typically with the tip terminating in the right atrium of the heart. This imaging technique confirms the catheter's placement and helps avoid complications.
How is the length of a PICC catheter determined?
The length of a PICC catheter is determined using a guidewire during the procedure. The wire is inserted into the vein and acts as a guide to measure the necessary catheter length, ensuring the tip reaches the desired central vein location, usually near the heart, for optimal function and minimal complications.