PROCEDURE: Tunneled Hickman catheter exchange with fluoroscopy

DATE: 

CLINICAL INDICATION: __ year-old female with malnutrition requiring TPN. Recently placed Hickman catheter broken. Needs new Hickman placed. 

OPERATING PHYSICIANS: John Doe, MD (Attending)/Jane Doe, MD (Fellow)    

MEDICATIONS: 100 mcg Fentanyl IV

ACCESS: Existing right chest wall tunneled Hickman catheter

CONTRAST: None

FLUOROSCOPY TIME: 3.1 minutes

COMPLICATIONS: None

IMPLANTABLE DEVICE: 9 French dual lumen Hickman catheter

 

PROCEDURE: After written and informed consent was obtained, the patient was placed supine on the procedure table. A surgical timeout was performed. 

The existing catheter and right chest/neck were prepped and draped in standard sterile fashion. A scout image was obtained. The indwelling heparin was withdrawn from the catheter lumens. The skin and subcutaneous tissue surrounding the catheter were anesthetized with 2% lidocaine. The catheter cuff was loosened with blunt dissection. A 0.035″ stiff Glidewire was advanced through the larger catheter lumen and into the IVC. The catheter was removed and a 10 French peel-away sheath was advanced over the wire and into the tunnel, with careful advancement into the right internal jugular vein. A new 9 French dual lumen Hickman catheter was advanced centrally over the guidewires using fluoroscopy. The peel-away sheath was removed and the guidewire was removed and the catheter was tested and flushed. The catheter was secured to the skin with 2-0 Ethilon and a biodisc and sterile dressing were applied. The patient tolerated the procedure well and there were no immediate complications.

 

FINDINGS: 

  1. Broken catheter seen on physical exam. Catheter tip in right atrium on scout radiograph.
  2. The new catheter tip terminates in the right atrium.

 

IMPRESSION:  Successful image-guided exchange of a 9 French dual lumen Hickman catheter.