DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Malignant melanoma and need for MediPort catheter for intravenous access.
POSTOPERATIVE DIAGNOSIS: Malignant melanoma and need for MediPort catheter for intravenous access.
OPERATION PERFORMED:
1. Left subclavian MediPort catheter insertion with C-arm control.
2. Left superior vena cavogram with contrast.
SURGEON: John Doe, MD
ASSISTANT: None.
ANESTHESIA: Local IV.
BLOOD REPLACEMENT: None.
BLOOD LOSS: Minimal.
DESCRIPTION OF PROCEDURE: With the patient in the supine position, SCD boots were placed and perioperative antibiotics were given. The chest wall was prepped and draped in the usual manner. Percutaneous puncture of left subclavian vein was performed. The wire was placed in excellent position. C-arm confirmed bladder to be in excellent position. Xylocaine 1% with epinephrine was placed into the field block and pocket was created, defatting pocket created.
MediPort was measured and was cut at approximately 21 cm from the bulbous end. Catheter had been pre-heparinized utilizing Cook Peel-Away sheath, and it was placed in excellent position. There was wonderful blood draw. Catheter was irrigated. It was somewhat difficult to see the exact tip of the catheter in view of the patient’s size; therefore, it was our decision to confirm excellent position of this catheter that was cut to 21 cm. We elected to do dye-contrast vena cavogram. Utilizing subtraction technique, this was performed, and the tip of the catheter was in excellent position above the atrium. The catheter was then reheparinized. The catheter was tacked to the pocket utilizing 2-0 Prolene at the bulbous end. We also placed a 3-0 Prolene suture because the catheter seemed to have a tendency to want to backout of the chest wall for a centimeter or two. If this happens, it could create kinking. Therefore, we placed this Prolene suture, and it seemed to resolve any future problem. Hemostasis was obtained.
The skin was reapproximated utilizing running subcuticular 4-0 Monocryl. Benzoin and Steri-Strips were applied. Appropriate dressing was placed. The patient left the operating room of the day surgery area in stable condition. Sponge and needle counts were reported as correct by the nursing staff.
Sample #2
DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Pulmonary embolism.
2. Poor intravenous access.
POSTOPERATIVE DIAGNOSES:
1. Pulmonary embolism.
2. Poor intravenous access.
OPERATIONS PERFORMED:
1. Attempted placement of Greenfield filter.
2. Insertion of MediPort catheter.
3. Placement of central venous catheter.
SURGEON: John Doe, MD
ANESTHESIA: MAC.
DESCRIPTION OF OPERATION: The patient was prepped and draped in the usual sterile fashion after instillation of 1% lidocaine into the right internal jugular vein. A guidewire was placed into the internal jugular vein and down to the right atrium under fluoroscopy through a #16 gauge trocar. This was unable to be passed as described above, and therefore, a trocar was placed into the right subclavian vein without difficulty with a good blood return. The guidewire, however, would not pass through the subclavian vein into the superior vena cava. Therefore, it was thought that a MediPort could be passed through the internal jugular vein.
An incision was made on the chest wall. A subcutaneous tissue pocket was created, and the MediPort was placed. The catheter was tunneled in a subcutaneous tissue tunnel. However, it was not functioning. Therefore, a portogram was performed, and the dye did not appear to be in a proper position. Therefore, the entire apparatus was removed.
The wound was irrigated with normal saline and closed with #3-0 plain catgut suture in an interrupted fashion and #4-0 Monocryl suture in a running subcuticular fashion. At this point, the patient was reprepped and draped and instilled with 1% lidocaine into the area of the right common femoral vein. A #16 gauge trocar was placed into the common femoral vein, and guidewire was placed under fluoroscopy into the femoral vein and then up into the iliac vein; however, it would not pass into the inferior vena cava, turning back into the left iliac system.
This guidewire was then removed, and a central venous catheter was placed into the left subclavian vein without difficulty instilling this with 1% lidocaine, placing this trocar within the subclavian vein and guidewire down into the right atrium and the central line over the guidewire. The guidewire was pulled down, and the central line was flushed with heparinized saline and tacked to the skin using #3-0 silk suture. The patient tolerated the procedure well and was taken back to the intensive care unit.
Sample #3
DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Metastatic pancreatic carcinoma.
POSTOPERATIVE DIAGNOSIS: Metastatic pancreatic carcinoma.
OPERATION PERFORMED: MediPort placement via left internal jugular.
SURGEON: John Doe, MD
DESCRIPTION OF PROCEDURE: After informed consent was obtained, the patient was taken to the OR and prepped and draped in sterile fashion. The patient was placed in steep Trendelenburg position. An ultrasound was used to identify the vein. The vein was then was accessed easily with a large bore needle. The guidewire was inserted and manipulated into the SVC right atrial junction.
Next, a subcutaneous pocket was created in the left anterior chest, and the catheter was then brought in through the subcutaneous tunnel from the left chest to left neck area. Next, the introducer sheath was inserted under fluoroscopic guidance and the catheter with the tip positioned in the SVC right atrial junction. The catheter was then attached to the port. The port was aspirated with good blood return and flushed with heparinized saline solution.
The port was secured in place with 2-0 Prolene. The incision was reapproximated with 3-0 Vicryl. Steri-Strips and sterile dressing were applied. The patient returned to recovery in stable condition.
