{"id":11538,"date":"2021-03-14T21:21:00","date_gmt":"2021-03-14T21:21:00","guid":{"rendered":"http:\/\/lavascular.com\/?p=11538"},"modified":"2021-03-14T21:21:00","modified_gmt":"2021-03-14T21:21:00","slug":"tunneled-non-cuffed-picc-line-central-venous-catheter-placement-technique-and-dictation","status":"publish","type":"post","link":"https:\/\/lavascular.com\/tunneled-non-cuffed-picc-line-central-venous-catheter-placement-technique-and-dictation\/","title":{"rendered":"Tunneled Non-cuffed (Picc Line) Central Venous Catheter Placement Technique and Dictation"},"content":{"rendered":"

PROCEDURE:\u00a0 TUNNELED CENTRAL VENOUS CATHETER WITH US & FLUORO\u00a0\u00a0<\/span><\/p>\n

DATE OF PROCEDURE: 01\/01\/2022<\/span><\/p>\n

CLINICAL INDICATION: Chemotherapy<\/span><\/p>\n

OPERATING PHYSICIANS: \u00a0 John Doe, MD (Attending)\/Jane Doe, MD (Fellow) \u00a0 \u00a0\u00a0<\/span><\/p>\n

MEDICATIONS:\u00a0 Local. 1 gram IV Ancef.. Versed and fentanyl IV<\/span><\/p>\n

ACCESS SITE: Right internal jugular vein with ultrasound<\/span><\/p>\n

CATHETER: 5 French double lumen PICC<\/a> cut to 25 cm<\/span><\/p>\n

FLUORO TIME: 0.6<\/span><\/p>\n

COMPLICATIONS<\/a>: None immediate.<\/span><\/p>\n

 <\/p>\n

PROCEDURE:\u00a0\u00a0<\/span><\/p>\n

 <\/p>\n

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.<\/span><\/p>\n

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.\u00a0 The skin and subcutaneous tissues were infiltrated with 2% Lidocaine without epinephrine.\u00a0 Under ultrasound guidance, the right internal jugular vein was accessed with a micropuncture needle.\u00a0 Vein patency and needle entry was documented and sent to PACS. An 0.018\u201d wire was advanced through the needle, and the needle was exchanged for a 6 French peel-away sheath.<\/span><\/p>\n

Attention was turned to the creation of a subcutaneous tunnel.\u00a0 A tract caudal and lateral to the sheath entry site was infiltrated with 2% Lidocaine with epinephrine.\u00a0 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.\u00a0 The catheter was brought through the tunnel to the venotomy and cut to length.\u00a0<\/span><\/p>\n

The catheter was advanced through the peel-away sheath and positioned centrally using fluoroscopy.\u00a0 The sheath was removed.\u00a0 The catheter was secured in place with the tip in the right atrium.\u00a0 The venotomy site was closed with Dermabond. \u00a0 Ethilon suture was placed at the tunnel exit site.\u00a0\u00a0<\/span><\/p>\n

The catheter ports<\/a> were flushed and heparinized per protocol.\u00a0 An antimicrobial disc and sterile dressing were applied.\u00a0<\/span><\/p>\n

The patient tolerated the procedure well and remained in stable condition throughout the stay in the angiography suite.<\/span><\/p>\n

 <\/p>\n

FINDINGS:<\/span><\/p>\n

    \n
  1. Patent right internal jugular vein. Needle entry was documented by ultrasound.<\/span><\/li>\n
  2. The catheter has a smooth course with the tip in the [right atrium].\u00a0\u00a0<\/span><\/li>\n<\/ol>\n

    \u00a0<\/span><\/p>\n

    IMPRESSION:\u00a0\u00a0<\/span><\/p>\n

    Successful image-guided placement of a right internal jugular tunneled, non-cuffed central venous catheter as described.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

    PROCEDURE:\u00a0 TUNNELED CENTRAL VENOUS CATHETER WITH US & FLUORO\u00a0\u00a0 DATE OF PROCEDURE: 01\/01\/2022 CLINICAL INDICATION: Chemotherapy OPERATING PHYSICIANS: \u00a0 John Doe, MD (Attending)\/Jane Doe, MD […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_themeisle_gutenberg_block_has_review":false,"jetpack_post_was_ever_published":false,"_ti_tpc_template_sync":false,"_ti_tpc_template_id":"","_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false}}},"categories":[32],"tags":[],"jetpack_publicize_connections":[],"yoast_head":"\nTunneled Non-cuffed (Picc Line) Central Venous Catheter Placement Technique and Dictation - 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