PROCEDURE: 

  1. Tunneled hemodialysis catheter exchange under fluoroscopy
  2. Central venogram through existing catheter
  3. Central venoplasty
  4. Post venoplasty central venogram

 

DATE:    

CLINICAL INDICATION:     

OPERATING PHYSICIANS: , MD (Attending)/   , MD (Fellow)

MEDICATIONS: Ancef 1 gram IV, Versed     mg IV, fentanyl     mcg IV

ACCESS: Existing     approach tunneled hemodialysis catheter

CONTRAST:    

FLUOROSCOPY TIME:     minutes

COMPLICATIONS: None

IMPLANTABLE DEVICE: 15.5 French x     cm tip-to-cuff hemodialysis catheter

 

PROCEDURE: After written and informed consent was obtained, the patient was placed supine on the procedure table. The existing catheter and     chest/neck were prepped and draped in standard sterile fashion. A scout image was obtained. The indwelling heparin was withdrawn from the catheter lumens. The skin and subcutaneous tissue surrounding the catheter were anesthetized with 2% lidocaine. The catheter cuff was loosened with blunt dissection. The catheter was pulled back and a central venogram was then obtained through the catheter. 

A 0.035″ stiff Glidewire was advanced through each catheter lumen and into the IVC. The catheter was removed over the guidewires and a     French sheath was placed over one of the guidewires. Through the sheath a     mm x 4 cm balloon was advanced over the guidewire and positioned over the fibrin sheath. The balloon was inflated and advanced centrally to disrupt the sheath. A repeat central venogram was then obtained through the sheath.  The balloon and sheath were removed and a new 15.5 French x     cm tip-to-cuff hemodialysis catheter was advanced centrally over the guidewires using fluoroscopy. The guidewires were removed and the catheter was tested, flushed, and charged with appropriate volumes of heparin. The catheter was secured to the skin with 2-0 Ethilon and a biodisc and sterile dressing were applied. The patient tolerated the procedure well and there were no immediate complications.

 

FINDINGS: 

  1. Scout image demonstrates a     approach tunneled hemodialysis catheter.
  2. Venogram through the existing catheter demonstrates    . 
  3. Following balloon disruption there is markedly improved flow through     with no evidence of residual fibrin sheath. 
  4. The new catheter tip terminates in the right atrium.
  5. Satisfactory function with 20 ml syringe test.

 

IMPRESSION:  Successful image-guided exchange of a     tunneled hemodialysis catheter and disruption of fibrin sheath as above.