PROCEDURE: Tunneled hemodialysis catheter / Permacath exchange with fluoroscopy

DATE:    

CLINICAL INDICATION:     

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

MEDICATIONS:     1 gram IV,    

ACCESS: Existing     tunneled hemodialysis catheter

CONTRAST: None

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 The indwelling heparin was withdrawn from the catheter lumens.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. A 0.035″ stiff Glidewire was advanced through each catheter lumen and into the IVC. The catheter was removed over the guidewires 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. The new catheter tip terminates in the right atrium.
  2. Satisfactory function with 20 ml syringe test.

 

IMPRESSION:  Successful image-guided exchange of a  ___ permcath / tunneled hemodialysis catheter as above.