Procedure:      chest port placement with imaging

Date:    

Indication:    

Access site:  Right internal jugular with ultrasound

Operator: Drs.    

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

Fluoro time:      minutes

Device:  BARD 8 French power 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 and the needle exchanged for a 5 French transitional dilator. The smaller wire was exchanged for a 0.035″ wire.  A  peel-away sheath was placed at the venotomy.

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 brought through the tunnel.  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 catheter was flushed, cut to length and attached to the port reservoir. 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 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. 

additional findings on images.

 

 

Impression: 

Uneventful image guided placement of right internal jugular single lumen power port as described.