DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Chronic renal failure.
2. Thrombosed graft fistula.
3. Right axillary vein stenosis.
POSTOPERATIVE DIAGNOSES:
1. Chronic renal failure.
2. Thrombosed graft fistula.
3. Right axillary vein stenosis.
PROCEDURE PERFORMED: Insertion of right internal jugular Permacath.
SURGEON: John Doe, MD
CLINICAL FINDINGS AND INDICATIONS: This (XX)-year-old male with chronic renal failure presented with a thrombosed graft fistula. The fistula was thrombectomized two days ago. The patient has a venous outflow stenosis, which was responsible for a re-thrombosis. A right internal jugular vein catheter was placed under fluoroscopy and ultrasound guidance. The patient has a very stiff neck, and it was difficult to manipulate the catheter due to the rigidity of the tissues. At the end of the procedure, the catheter was placed in good position and had excellent flow and inflow.
DESCRIPTION OF PROCEDURE: The neck was prepared in the usual manner. The skin was infiltrated with Carbocaine 0.25%. The right internal jugular vein was accessed after finding it with ultrasound. A percutaneous stick was placed. A guidewire was introduced. Through this, a sheath and dilator were introduced. Again, due to the rigidity of the neck, the patient had to be manipulated due to the 90 degree bend at the level of the cervicothoracic junction. The introducer was placed. The catheter with a wire was introduced into the superior vena cava. The catheter was then tunneled in the anterior chest wall. This was a 27 Arrow Cannon. The tubing was placed and the catheter flushed for inflow and outflow and performed well. The catheter was fastened to the skin with 3-0 Prolene. The incision was closed, subcuticular with 4-0 Monocryl, and Steri-Strips were applied. The patient left the OR in stable condition.
DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Chronic renal failure.
POSTOPERATIVE DIAGNOSIS: Chronic renal failure.
PROCEDURE PERFORMED: Insertion of right external jugular Permacath.
SURGEON: John Doe, MD
CLINICAL FINDINGS AND INDICATIONS: This is a patient who is (XX)years of age who presented for insertion of a tunneled catheter. The patient’s right external jugular veins were thrombosed, and the catheter was placed through a left external jugular approach.
DESCRIPTION OF PROCEDURE: The patient’s neck was prepped in the usual manner. The skin was infiltrated with Carbocaine 1%. Attempts at small needle insertion were unsuccessful. The neck was scanned, and there was no internal jugular vein on either side. The right external jugular vein was accessed with a small mini-stick and a small guidewire was introduced. Through this, a small sheath was introduced. The guidewire was introduced in the superior vena cava. Under direct vision, dilators were introduced and then the introducer. A 23 Arrow Cannon catheter was placed at the superior vena cava and atrial junction tunneling in the anterior chest wall and transected. Attachments were placed, flushed with inflow and outflow and performed well. The catheter was fastened to the skin with 3-0 Prolene. The tunnel was closed with 4-0 Maxon. The patient left the OR in stable condition.
NOTE: PermCath is the preferred and correct word, though Permacath can also be found on reference sources. Go with PermCath if no specific request for “Permacath” is made by the doctor.
