DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Gastric cancer, needs port for chemotherapy access.
POSTOPERATIVE DIAGNOSIS:
Gastric cancer, needs port for chemotherapy access.
PROCEDURE PERFORMED:
Placement of port, left cephalic vein.
SURGEON: John Doe, MD
ASSISTANTS: None.
ANESTHESIA: Local anesthesia with intravenous sedation.
DESCRIPTION OF PROCEDURE: After proper consent was obtained, the patient was brought to the operating room and placed on the table in supine position, and local anesthesia with intravenous sedation was administered. The patient tolerated this well. The left and right neck and chest regions were prepped and draped in sterile manner. Then, 0.5% plain Marcaine solution was injected for local anesthetic at the operative site.
Incision was made in the left deltopectoral groove region with a #15 blade. Dissection was carried down with cautery down to the pectoralis major muscle at its superior edge. The adjacent cephalic vein was identified and dissected free for a length of 1.5 cm. Then, 3-0 Vicryl sutures were placed around the proximal and distal aspects of the exposed vein. The distal tie was tied. The anterior surface of the vein was opened with scissors. A vein pick was inserted into the vein where it had been open on the anterior surface to facilitate guidance of the catheter into the vein. The catheter was then advanced under fluoroscopic guidance to position the tip at the cavoatrial junction. The proximal tie was then tied to secure the catheter in place. The catheter was cut at appropriate length and secured to the port and the port was placed into the subcutaneous pocket, which was dissected medial and inferior to the incision. The port was secured to underlying tissue with interrupted 2-0 Vicryl suture x2. The operative fields were inspected and noted to be hemostatic.
The incision was closed in layers using interrupted 3-0 Vicryl to close the subcutaneous layer and running 4-0 subcuticular Vicryl suture to close the skin. Benzoin, Steri-Strips, and sterile gauze dressings were placed. The patient’s port was then accessed with a Huber needle and was left to access for use by the nurses postoperatively on the ward. The port was aspirated and was noted to aspirate blood freely. The port was then flushed with heparinized saline. The patient was taken back to her room postoperatively. She tolerated the procedure well. Sterile dressings were placed after the procedure was performed.
