PROCEDURE: Translumbar tunneled central venous catheter placement
MEDICATIONS: Ancef 1 gram IV; General anesthesia provided by the Anesthesiology team.
FLUOROSCOPY TIME: minutes
IMPLANTABLE DEVICE: 15.5 French x cm tip-to-cuff hemodialysis catheter, lot #
PROCEDURE: After written and informed consent was obtained, the patient was placed prone on the procedure table. General anesthesia and physiologic monitoring was provided by personnel from the Department of Anesthesiology. The right flank was prepped and draped in standard sterile fashion. Skin and subcutaneous tissues overlying the right iliac crest was anesthetized with local, and a small skin incision was made. Using fluoroscopic guidance a 22-gauge x 20 cm Chiba needle was advanced towards the anterior aspect of the mid L3 vertebral body. The needle was withdrawn while aspirating until blood return was obtained. Contrast was then injected to confirm needle position within the inferior vena cava. A 0.018 inch guidewire was advanced through the needle toward the right atrium. Over the guidewire A 6F Accustick transition catheter was advanced into the IVC. The metallic stiffener was removed. The 0.018 inch guidewire was used to measure intravascular length. The inner dilator and wire were removed and a 0.035 inch Amplatz guidewire was advanced through the catheter into the right atrium. An approximate 12 cm skin tract lateral to the dermatotomy site was anesthetized with local. A second dermatotomy was made and the catheter was tunneled beneath the skin. The Accustick catheter was removed over the guidewire, and the tract was serially dilated. A 16 French peel-away sheath was advanced over the guidewire. The inner dilator and guidewire were removed and the catheter was positioned centrally through the sheath under fluoroscopy. The sheath was removed. The catheter was tested, flushed, and heparinized. The venotomy site was closed with interrupted 4-0 Monocryl and Dermabond. The catheter was secured at the exit site with 2-0 Ethilon. A biodisc and sterile dressings were applied. The patient tolerated the procedure well without immediate complications. The patient was brought to the PACU in stable condition for post-procedural care.
- Scout image of the right flank is unremarkable.
- Contrast injection through the Chiba needle confirms location in the inferior vena cava.
- Catheter tip terminates in the right atrium and there is a smooth course through the tunnel tract.
IMPRESSION: Successful placement of a translumbar tunneled hemodialysis catheter as above.