Portacath removal and new port placement technique and dictation

1. CHEST PORT (VORTEX-DOUBLE LUMEN) PLACEMENT WITH ULTRASOUND & FLUOROSCOPIC GUIDANCE
2. CHEST PORT REMOVAL

DATE OF PROCEDURE: 

CLINICAL INDICATION: __ year-old patient with sickle cell disease needing existing port removed and placement of Vortex double lumen port for transfusions. 

MEDICATIONS:  2% Lidocaine without and with epinephrine SQ for local anesthesia, Ancef 1 gm IV, Versed 2 mg IV, Fentanyl 100 mcg IV

FLUOROSCOPY TIME: 1.2 minutes

CATHETER: Single lumen Vortex port

PUNCTURE SITE: Right internal jugular vein

PROCEDURE:  

After the risks and benefits of the procedure and of conscious sedation were explained, informed consent was obtained.  With the patient in the supine position, the right neck and upper chest were prepped and draped in standard sterile fashion. A surgical timeout was performed. 

The skin and subcutaneous tissues overlying the right internal jugular vein were infiltrated with local.  Under ultrasound guidance, the right internal jugular vein was successfully cannulated with a micropuncture needle and a 0.018″ wire was advanced through the needle into the vein. The needle was exchanged for a 5 French coaxial dilator.  The wire was used to measure the intravascular catheter length prior to removal.  The introducer of the coaxial catheter was removed and a 0.035″ guidewire was passed into the IVC and secured.

Attention was turned to the creation of a subcutaneous pocket and tunnel.  The chest wall pocket site and catheter tunnel were infiltrated with local medial to the existing port.  A second dermatotomy was made and the pocket was bluntly dissected.  The tunneling tool was passed and the catheter was pulled through the initial venotomy site. The catheter was cut to length.  The transition catheter was exchanged for a peel-away sheath.  The catheter was advanced through the sheath and positioned centrally using fluoroscopy.  The port was flushed and heparinized.  The venotomy site was closed with Dermabond.  The pocket was closed in single layer with 2-0 Vicryl and Dermabond.  Steri-strips were applied to the skin surface.  A sterile dressing was applied.

Attention was then focused on the existing right chest wall port. The skin and subcutaneous tissues surrounding the previously existing port were anesthetized with 2% lidocaine with epinephrine. A 2 cm skin incision was made with a #15 blade. Blunt dissection was used to mobilize the port and its catheter. The catheter was retracted from the vein and hemostasis was obtained with manual compression. The port was then easily removed. The incision was closed with interrupted 3-0 Vicryl sutures. Dermabond, Steri-Strips, and a sterile dressing were applied. The patient tolerated the procedure well without any immediate complications.

The patient tolerated the procedure well and remained in stable condition throughout the stay in the angiography suite.  

FINDINGS:

1. Scout radiograph demonstrates existing right chest wall port with tip in cavoatrial junction.
2. Patent right internal jugular vein by ultrasound.  Needle entry was documented with ultrasound and an image was saved to PACS.
3. New catheter tip is in the right atrium.

IMPRESSION:  

1. Successful  image-guided placement of a right internal jugular approach single lumen Vortex chest port.
2. Successful removal of right chest wall port.