Procedure: Power injectable chest port placement with imaging

Date: 5/16/2022

Indication:    

Access site:  Right internal jugular with ultrasound

Operator:   John Doe, MD (Attending)/Jane Doe, MD (Fellow)        

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

Fluoro time:      minutes

Device:  BARD 6.6F low profile chest port

Complications: None immediate

 

Technique:

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

The patient was assessed for conscious sedation and found to be an acceptable candidate. A dedicated nurse monitored heart rate, blood pressure, and oxygen saturation throughout the procedure 

The right neck and chest wall region was prepped and draped in sterile fashion. Using local anesthetic and ultrasound guidance, the     vein was punctured with a 21 gauge needle. A PACS image was stored.  A 0.018″ wire was passed centrally.  

The soft tissues caudal and lateral to the sheath entry site were anesthetized with lidocaine with epinephrine. A #15 blade was used to incise the skin.  Blunt and sharp dissection were used to create a subcutaneous pocket.  The pocket was irrigated with 50 cc antibiotic solution.

A tunneling tool was brought from the pocket to the venotomy. The catheter was flushed, attached to the port reservoir and brought through the tunnel. The  needle exchanged for a 5 French transitional dilator. The smaller wire was exchanged for a 0.035″ wire.  A 7 French peel-away sheath was placed at the venotomy.  The catheter was cut to length to reach mid RA . During suspended respiration, the catheter was advanced through the peel-away and positioned centrally using fluoroscopy. The peel-away sheath was removed and hemostasis achieved with manual compression.The reservoir was aspirated, flushed, and heparinized per protocol.  It was sutured/placed into the pocket using a single 3-0 Ethilon suture.

The pocket was closed using absorbable Vicryl suture and Dermabond.  The venotomy was closed with 3-0 Vicryl and Dermabond.  Steri-Strips and a sterile dressing were applied. The procedure was well tolerated, and the patient discharged from the angiography suite in satisfactory condition.

 

Findings:

The  ____ vein is ultrasonographically patent and compresses.  Needle entry was stored to PACS.

The port catheter has a smooth course with the tip terminating in the right atrium. 

[Multiple Pacer wires are noted over the chest ]

 

Impression: 

Uneventful image guided placement of right internal jugular low profile chest wall port catheter as described.