Procedure: PleurX tunneled peritoneal drainage catheter placement with ultrasound and fluoro with large volume paracentesis       

Indication: Ascites.      

Date:     

Operators: Drs.     

Medications:     mg IV Versed,     mcg IV fentanyl and 1 g IV Ancef

Albumen:      g IV

Catheter:  15F PleurX Catheter

Specimen:      liters

Access site:      quadrant with ultrasound

Complications:  None immediate.

 

Technique: 

The risks, benefits, and alternatives to the procedure and sedation were explained to the patient. The specific risks of bleeding, infection, and damage to adjacent bowel loops were detailed and accepted. Written informed consent was obtained.  A timeout was performed.

The anterior abdominal wall was prepped and draped in sterile fashion. Ultrasonographic evaluation was carried out, and an appropriate entry site identified in the    . Using local anesthetic and ultrasound guidance, the peritoneal space was accessed with a 21 gauge needle.  Clear yellow fluid was returned. Needle entry was documented, and images transferred to PACS.

A 0.018” wire was placed through the needle, and the needle exchanged for a 5 French transitional dilator. The smaller wire was replaced with a short Amplatz wire. The skin tract was dilated and a 16 French peel-away sheath placed over the wire.

The soft tissues cephalad and medial to the sheath entry site were anesthetized with 2% lidocaine with epinephrine. A dermatotomy was created, and the PleurX catheter was pulled through the tunnel with the tunneling device. The cuff was positioned in the     of the tunnel.

The intraperitoneal wire and dilator were removed, and the catheter was placed through the peel-away. It was positioned using fluoroscopy. The peel-away was removed.

The peritoneal puncture site was closed in two layers with 4-0 absorbable   suture and Dermabond.  Steri-Strips were applied.   2-0 Ethilon sutures were placed at the tunnel exit site to secure the catheter.  A sterile dressing was applied.

Subsequently, large volume paracentesis was performed through the newly placed catheter. A total of     liters clear yellow fluid were removed.

The procedure was well tolerated, and the patient was discharged in satisfactory condition.

 

Findings:

  1. There is     ascites.
  2. The peritoneal catheter is positioned    .
  3. Total volume removed was    .

 

Impression:

Tense ascites.

Uneventful image guided placement of 15 French multi sidehole PleurX intraperitoneal  catheter to facilitate frequent large volume paracentesis.

__  liters clear yellow fluid were removed without incident.

Arrangements were made for supply access and patient/caregiver teaching.