Procedure:  Ultrasound & fluoro guided tunneled Trifusion catheter           

Indication:     

Date:     

Operators:  Drs.    

Access Site:  name side and vein with ultrasound

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

Fluoroscopy time:      minutes

Catheter:  12 French,     cm tip to cuff Trifusion 

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 right neck and chest region was prepped and draped in sterile fashion. The region was ultrasonographically evaluated.  Using local anesthetic and ultrasound guidance, the right internal jugular vein was punctured with a 21 gauge needle.  An image documenting vein patency and needle entry was saved and stored to PACS. 

A 0.018” wire was passed centrally and the needle exchanged for a 5 French transitional dilator. A 0.035” wire was advanced through the dilator and negotiated into the IVC.  The skin tract was dilated and a 13 French dilator peel-away combination placed over the wire.

The soft tissues caudal and lateral to the sheath entry site were anesthetized with lidocaine with epinephrine. A dermatotomy was made and a tunneling tool brought from the dermatotomy 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 was removed and hemostasis achieved with manual compression.

The venotomy was closed with Dermabond and Steri-Strips applied. A single  Ethilon suture was placed at the catheter tunnel exit site. An antimicrobial disc and sterile dressing were applied.

The catheter was aspirated, flushed, and heparinized per protocol. The procedure was well tolerated, and the patient was discharged in satisfactory condition.

 

Findings:

  1. The     vein is ultrasonographically patent and normal. Vein patency and needle entry were stored to PACS.
  2. The newly placed catheter has a smooth course with the tip terminating in the right atrium.
  3. additional findings on images.

 

Impression: 

Uneventful image guided placement of     tunneled trifusion catheter as described.