PROCEDURE:  TUNNELED CENTRAL VENOUS CATHETER WITH US & FLUORO  

DATE OF PROCEDURE: 01/01/2022

CLINICAL INDICATION: Chemotherapy

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

MEDICATIONS:  Local. 1 gram IV Ancef.. Versed and fentanyl IV

ACCESS SITE: Right internal jugular vein with ultrasound

CATHETER: 5 French double lumen PICC cut to 25 cm

FLUORO TIME: 0.6

COMPLICATIONS: None immediate.

 

PROCEDURE:  

 

The risks, benefits, and alternatives to the procedure and sedation were explained to the patient. The specific risks of bleeding, infection and pneumothorax were detailed and accepted. Written informed consent was obtained. A time out/call to order was performed prior to procedure initiation.

The patient was placed in the supine position in the angiography table and the left neck and upper chest were prepped and draped in the usual sterile fashion.  The skin and subcutaneous tissues were infiltrated with 2% Lidocaine without epinephrine.  Under ultrasound guidance, the right internal jugular vein was accessed with a micropuncture needle.  Vein patency and needle entry was documented and sent to PACS. An 0.018” wire was advanced through the needle, and the needle was exchanged for a 6 French peel-away sheath.

Attention was turned to the creation of a subcutaneous tunnel.  A tract caudal and lateral to the sheath entry site was infiltrated with 2% Lidocaine with epinephrine.  A second dermatotomy was made. The tunneling tool was passed from the access site through the subcutaneous soft tissues to the anterior lateral sub cutaneous tissue -7cm.  The catheter was brought through the tunnel to the venotomy and cut to length. 

The catheter was advanced through the peel-away sheath and positioned centrally using fluoroscopy.  The sheath was removed.  The catheter was secured in place with the tip in the right atrium.  The venotomy site was closed with Dermabond.   Ethilon suture was placed at the tunnel exit site.  

The catheter ports were flushed and heparinized per protocol.  An antimicrobial disc and sterile dressing were applied. 

The patient tolerated the procedure well and remained in stable condition throughout the stay in the angiography suite.

 

FINDINGS:

  1. Patent right internal jugular vein. Needle entry was documented by ultrasound.
  2. The catheter has a smooth course with the tip in the [right atrium].  

 

IMPRESSION:  

Successful image-guided placement of a right internal jugular tunneled, non-cuffed central venous catheter as described.