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:
- The right internal jugular vein is ultrasonographically patent. Needle entry was documented.
- The newly placed catheter has a smooth course with the tips terminating in the right atrium.
- There is excellent function with 20 ml syringes.
IMPRESSION:
Uneventful image guided placement of a right internal jugular tunneled hemodialysis catheter as described.
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