DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Gastric B-cell lymphoma.
POSTOPERATIVE DIAGNOSIS: Gastric B-cell lymphoma.
PROCEDURE PERFORMED: Left subclavian Port-A-Cath placement.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
INDICATIONS FOR PROCEDURE: This is a (XX)-year-old male with gastric B-cell lymphoma needing a Port-A-Cath for chemotherapy. The left subclavian route was chosen.
DESCRIPTION OF PROCEDURE: The patient was placed supine with a rolled towel between the shoulder blades. The bed was placed in slight Trendelenburg position and the right and left chest and neck prepped and draped with sterile technique. Central catheter was flushed with heparin to ensure its function. Landmarks were identified on the skin, and an entrance site was chosen 1-2 cm inferiorly to the distal third of the clavicle. The skin and subcutaneous tissues were anesthetized with 1% lidocaine, and local anesthesia was carried down to the periosteum of the clavicle.
The vein was then located with a 16-gauge needle and a 10 mL syringe. The needle was inserted in chosen site with the bevel down and directed towards the sternal notch with continuous negative pressure in the syringe. The needle was advanced in step-wise fashion down the clavicle. The vein was located, and the needle passed beneath the bone. The syringe began to fill with venous blood. The needle was rotated 90 degrees so the bevel was pointed towards the foot of the bed. Needle position was secured and the syringe removed. The hub was occluded to prevent venous embolus, and the guidewire was then passed easily and the needle removed while the wire was held in place. A small incision was then made at the point of entry of the wire and dilator and sheath then passed over the wire and tract gently dilated. This was done under fluoroscopic guidance. Fluoroscopy was used to check wire positioning and reaffirm proper placement.
At this time, the catheter was fed through the dilator sheath, and fluoroscopic guidance was again used to check proper catheter position. Once the catheter position was obtained at the junction of the right atrium and superior vena cava, a small incision was made approximately 3 cm below the access site into the subclavian. The subcutaneous tissue was dissected for placement of the port. Once adequate space was obtained for the port, the catheter was cut to fit and port connected, aspirated and flushed with heparin. The port was functioning properly and was sutured into place using 2-0 silk sutures.
At this time, the skin was then closed using 3-0 Vicryl sutures, and a subcutaneous 4-0 Monocryl was used to close the skin. The incision was then cleaned with a sterile dressing placed with benzoin and Steri-Strips. The patient tolerated the procedure well and was transferred to the postanesthesia care unit in stable condition. An upright chest x-ray was obtained to evaluate the location of catheter tip and check for a pneumothorax.
