{"id":11674,"date":"2021-03-24T04:16:43","date_gmt":"2021-03-24T04:16:43","guid":{"rendered":"http:\/\/lavascular.com\/?p=11674"},"modified":"2021-03-24T04:16:43","modified_gmt":"2021-03-24T04:16:43","slug":"permacath-exchange-and-disruption-of-a-fibrin-sheath-technique-and-dictation","status":"publish","type":"post","link":"https:\/\/lavascular.com\/permacath-exchange-and-disruption-of-a-fibrin-sheath-technique-and-dictation\/","title":{"rendered":"Permacath Exchange and disruption of a Fibrin Sheath Technique and Dictation"},"content":{"rendered":"

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

    \n
  1. Tunneled hemodialysis<\/a> catheter exchange under fluoroscopy<\/span><\/li>\n
  2. Central venogram through existing catheter<\/span><\/li>\n
  3. Central venoplasty<\/span><\/li>\n
  4. Post venoplasty central venogram<\/span><\/li>\n<\/ol>\n

     <\/p>\n

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

    CLINICAL INDICATION:\u00a0\u00a0\u00a0\u00a0\u00a0<\/span><\/p>\n

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

    MEDICATIONS: Ancef 1 gram IV, Versed \u00a0 \u00a0 mg IV, fentanyl \u00a0 \u00a0 mcg IV<\/span><\/p>\n

    ACCESS: Existing \u00a0 \u00a0 approach tunneled hemodialysis catheter<\/span><\/p>\n

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

    FLUOROSCOPY TIME: \u00a0 \u00a0 minutes<\/span><\/p>\n

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

    IMPLANTABLE DEVICE: 15.5 French x \u00a0 \u00a0 cm tip-to-cuff hemodialysis catheter<\/span><\/p>\n

     <\/p>\n

    PROCEDURE: After written and informed consent was obtained, the patient was placed supine on the procedure table. The existing catheter and \u00a0 \u00a0 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 The indwelling heparin was withdrawn from the catheter lumens.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. The catheter was pulled back and a central venogram was then obtained through the catheter.\u00a0<\/span><\/p>\n

    A 0.035″ stiff Glidewire was advanced through each catheter lumen and into the IVC. The catheter was removed over the guidewires and a \u00a0 \u00a0 French sheath was placed over one of the guidewires. Through the sheath a \u00a0 \u00a0 mm x 4 cm balloon was advanced over the guidewire and positioned over the fibrin sheath. The balloon was inflated and advanced centrally to disrupt the sheath. A repeat central venogram was then obtained through the sheath.\u00a0 The balloon and sheath were removed and a new 15.5 French x \u00a0 \u00a0 cm tip-to-cuff hemodialysis catheter was advanced centrally over the guidewires using fluoroscopy. The guidewires were removed and the catheter was tested, flushed, and charged with appropriate volumes of heparin. 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.<\/span><\/p>\n

     <\/p>\n

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

      \n
    1. Scout image demonstrates a \u00a0 \u00a0 approach tunneled hemodialysis catheter.<\/span><\/li>\n
    2. Venogram through the existing catheter demonstrates\u00a0 \u00a0 .\u00a0<\/span><\/li>\n
    3. Following balloon disruption there is markedly improved flow through \u00a0 \u00a0 with no evidence of residual fibrin sheath.\u00a0<\/span><\/li>\n
    4. The new catheter tip terminates in the right atrium.<\/span><\/li>\n
    5. Satisfactory function with 20 ml syringe test.<\/span><\/li>\n<\/ol>\n

       <\/p>\n

      IMPRESSION:\u00a0 Successful image-guided exchange of a \u00a0 \u00a0 tunneled hemodialysis catheter and disruption of fibrin sheath as above.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

      PROCEDURE:\u00a0 Tunneled hemodialysis catheter exchange under fluoroscopy Central venogram through existing catheter Central venoplasty Post venoplasty central venogram   DATE:\u00a0\u00a0\u00a0\u00a0 CLINICAL INDICATION:\u00a0\u00a0\u00a0\u00a0\u00a0 OPERATING PHYSICIANS: , […]<\/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":"\nPermacath Exchange and disruption of a Fibrin Sheath Technique and Dictation - 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