{"id":11870,"date":"2021-04-07T04:08:29","date_gmt":"2021-04-07T04:08:29","guid":{"rendered":"https:\/\/lavascular.com\/?p=11870"},"modified":"2021-04-08T05:31:34","modified_gmt":"2021-04-08T05:31:34","slug":"permcath-permacath-tunneled-hemodialysis-catheter-placement-technique-and-dictation","status":"publish","type":"post","link":"https:\/\/lavascular.com\/permcath-permacath-tunneled-hemodialysis-catheter-placement-technique-and-dictation\/","title":{"rendered":"Permcath\/Permacath\/Tunneled hemodialysis catheter placement technique and dictation"},"content":{"rendered":"

PROCEDURE: Ultrasound and fluoroscopy guided tunneled hemodialysis<\/a> catheter placement\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/span><\/p>\n

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

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

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

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

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

CONTRAST: None\u00a0<\/span><\/p>\n

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

CATHETER: 15.5 French, \u00a0 \u00a0 cm tip to cuff catheter<\/span><\/p>\n

COMPLICATIONS<\/a>:\u00a0 None\u00a0<\/span><\/p>\n

 <\/p>\n

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

The risks, benefits, and alternatives to the procedure and sedation were explained.\u00a0 Written informed consent was obtained.\u00a0 A timeout was performed.<\/span><\/p>\n

The right neck and upper chest were prepped and draped in sterile fashion. Using local anesthetic and ultrasound guidance, the right internal jugular vein was punctured with a 21 gauge needle. An image was saved and stored to PACS.\u00a0<\/span><\/p>\n

A 0.018-inch wire was passed centrally and the needle exchanged for a 5 French transitional dilator. A 0.035-inch wire was advanced through the dilator and negotiated into the IVC.\u00a0 The skin tract was dilated and a 16 French dilator peel-away combination placed over the wire.<\/span><\/p>\n

The soft tissues caudal and lateral to the sheath entry site were anesthetized with lidocaine with epinephrine. A dermatotomy was made and a tunneling tool brought from the dermatotomy to the venotomy. The catheter was brought through the tunnel.<\/span><\/p>\n

During suspended respiration, the catheter was advanced through the peel-away and positioned centrally using fluoroscopy. The peel-away was removed and hemostasis achieved with manual compression.<\/span><\/p>\n

The venotomy was closed with Dermabond and Steri-Strips applied.\u00a0 The catheter was secured with 2-0 Ethilon.\u00a0 An antimicrobial disc and sterile dressing were applied.<\/span><\/p>\n

The catheter was aspirated, flushed, and heparinized per protocol. The procedure was well tolerated, and the patient was discharged in satisfactory condition.<\/span><\/p>\n

 <\/p>\n

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

    \n
  1. The right internal jugular vein is ultrasonographically patent. Needle entry was documented.<\/span><\/li>\n
  2. The newly placed catheter has a smooth course with the tips terminating in the right atrium.<\/span><\/li>\n
  3. There is excellent function with 20 ml syringes.<\/span><\/li>\n<\/ol>\n

     <\/p>\n

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

    Uneventful image guided placement of a right internal jugular tunneled hemodialysis catheter as described.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

    PROCEDURE: Ultrasound and fluoroscopy guided tunneled hemodialysis catheter placement\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 INDICATION:\u00a0\u00a0\u00a0\u00a0 DATE:\u00a0\u00a0\u00a0\u00a0 OPERATORS: , MD (Attending)\/ \u00a0 , MD (Fellow) ACCESS SITE: Right internal jugular vein […]<\/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":"\nPermcath\/Permacath\/Tunneled hemodialysis catheter placement technique and dictation - 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