DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Right breast cancer.
2. Inadequate peripheral venous access for chemotherapy.
POSTOPERATIVE DIAGNOSES:
1. Right breast cancer.
2. Inadequate peripheral venous access for chemotherapy.
PROCEDURE PERFORMED: Mediport insertion with fluoroscopy and right lumpectomy.
SURGEON: John Doe, MD
ANESTHESIA: Intravenous sedation.
COMPLICATIONS: None.
ESTIMATED BLOOD LOSS: 30 mL.
INDICATIONS FOR PROCEDURE: The patient underwent lumpectomy and node dissection for a stage II carcinoma of the right breast. She has inferior margin involvement. She will require chemotherapy. A request was made for central venous access, so the patient returns for clearance of the inferior margin.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and placed in a supine position. After induction of adequate intravenous sedation, she was prepped with Betadine and draped in appropriate fashion. In the Trendelenburg position, the left subclavicular area was anesthetized with Xylocaine and Marcaine with epinephrine. The left subclavian vein was entered, and the guidewire was passed without resistance. It was seen on fluoroscopy to be in a central venous circulation.
A transverse incision was made inferior to the puncture site and deep into the chest wall where a pocket was created and a port was anchored in place with 2-0 Prolene sutures. The catheter was cut to the appropriate length and tunneled to the puncture site. A venous dilator was passed over the guidewire and the dilator was removed. The dilator and peel-away sheath were passed together with a guidewire, and the guidewire and dilator were then removed. The catheter was passed with a peel-away sheath and the sheath was removed. There was good blood return from the catheter and the catheter flushed easily. Fluoroscopy showed the tip to be in the proximal superior vena cava.
The wounds were then closed with interrupted 3-0 Vicryl for the deep tissue followed by subcuticular 4-0 Monocryl for the skin. The patient was then put in the supine semi upright sitting position, and the previous right lumpectomy incision was reopened. This was deep into the subcutaneous tissue and the previous deep closure was undone. The inferior margin tissue was grasped with Allis clamps and tissue was excised for a thickness of approximately 1 to 1.5 cm down to the chest wall. This was marked with the suture on the side of the new inferior margin.
Hemostasis was assured with pressure and cautery. The wound was irrigated and closure was performed with a running 2-0 Vicryl for the deep tissue followed by running subcuticular 4-0 Monocryl for the skin. Benzoin and Steri-Strips were applied. Dressings were applied. The patient tolerated the procedure well and had no complications. Blood loss was 30 mL, and the patient was taken to the recovery room in stable condition.
