PROCEDURE: Tunneled Non-cuffed Central Venous Catheter Placement Under Ultrasound & Fluoro Guidance
MEDICATIONS: Ancef 1 gm IV
ACCESS: Right internal jugular vein with ultrasound
FLUOROSCOPY TIME: minutes
CATHETER: 5 French dual lumen power PICC
PROCEDURE: Informed, written consent was obtained after explaining the risks and benefits of the procedure. With the patient in the supine position, the right neck and upper chest were prepped and draped in the usual sterile fashion. The right internal jugular vein was identified with ultrasound. The overlying skin and subcutaneous tissues were infiltrated with 2% Lidocaine without epinephrine. Under ultrasound guidance, the right internal jugular vein was successfully cannulated using a micropuncture needle. An 0.018″ wire was advanced through the needle into the vein. The needle was exchanged for a 5.5-F peel away sheath, and the wire was used to measure the intravascular length before removal. The sheath was aspirated and capped.
Attention was turned to the creation of a subcutaneous tunnel. Local anesthetic was infiltrated along a 10-12 cm tract caudal and lateral to the initial venotomy site. A second small dermatotomy was made. The catheter was tunneled through the skin to the venotomy site using a tunneling stylet and the catheter was cut to length.
The introducer was removed from the sheath and the PICC catheter was advanced through the sheath and positioned centrally under fluoroscopic guidance. The venotomy site was closed with Dermabond. A 3-0 Ethilon suture was used to secure the catheter at the exit site. The patient tolerated the procedure well and remained in stable condition throughout the stay in the angiography suite. The catheter was flushed, heparinized, and a sterile dressing was applied.
- Patent right internal jugular vein by ultrasound. An image documenting needle entry was saved in PACS.
- Tip of the catheter terminates in the right atrium.
IMPRESSION: Successful image-guided placement of a non-cuffed tunneled right internal jugular approach dual lumen PICC line.