PROCEDURE: Ultrasound and fluoroscopy guided tunneled hemodialysis catheter placement         

INDICATION:    

DATE:    

OPERATORS: , MD (Attending)/   , MD (Fellow)

ACCESS SITE: Right internal jugular vein with ultrasound

MEDICATIONS: Versed     mg IV, fentanyl     mcg IV, and    

CONTRAST: None 

FLUOROSCOPY TIME:     minutes

CATHETER: 15.5 French,     cm tip to cuff catheter

COMPLICATIONS:  None 

 

TECHNIQUE:

The risks, benefits, and alternatives to the procedure and sedation were explained.  Written informed consent was obtained.  A timeout was performed.

The right neck and upper chest were prepped and draped in sterile fashion. Using local anesthetic and ultrasound guidance, the right internal jugular vein was punctured with a 21 gauge needle. An image was saved and stored to PACS. 

A 0.018-inch wire was passed centrally and the needle exchanged for a 5 French transitional dilator. A 0.035-inch wire was advanced through the dilator and negotiated into the IVC.  The skin tract was dilated and a 16 French dilator peel-away combination placed over the wire.

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 brought from the dermatotomy to the venotomy. The catheter was brought through the tunnel.

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 venotomy was closed with Dermabond and Steri-Strips applied.  The catheter was secured with 2-0 Ethilon.  An antimicrobial disc and sterile dressing were applied.

The catheter was aspirated, flushed, and heparinized per protocol. The procedure was well tolerated, and the patient was discharged in satisfactory condition.

 

FINDINGS:

  1. The right internal jugular vein is ultrasonographically patent. Needle entry was documented.
  2. The newly placed catheter has a smooth course with the tips terminating in the right atrium.
  3. There is excellent function with 20 ml syringes.

 

IMPRESSION: 

Uneventful image guided placement of a right internal jugular tunneled hemodialysis catheter as described.