DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Poor vascular access and nonfunctioning left arm PassPort.
2. Chronic cystic fibrosis requiring intravenous antibiotics.
POSTOPERATIVE DIAGNOSES:
1. Poor vascular access and nonfunctioning left arm PassPort.
2. Chronic cystic fibrosis requiring intravenous antibiotics.
OPERATION PERFORMED: Replacement of left arm PassPort.
SURGEON: John Doe, MD
ANESTHESIA: Straight local with monitoring of vital signs by Anesthesia.
INDICATIONS FOR OPERATION: This (XX)-year-old lady has had a PassPort for the past four months. Unfortunately, it was noted to be clotted and could not be cleared. She still required vascular access, and we discussed the options with her, of removing it or replacing it. We recommended straight local anesthesia because of her comorbid diseases, and she agreed with this. The procedure, risks, and benefits were discussed. The potential of not being able to replace it was discussed. She voiced understanding and agreed.
DESCRIPTION OF OPERATION: After the patient was brought to the operating room and positioned on the table so that she was comfortable at a 45-degree angle, the arm was placed out. The arm was prepped with Betadine. Sterile drapes were applied in the usual manner. Local anesthesia was infiltrated in the skin and subcutaneous tissue at her previous incision and port site.
The incision was made down to the port, which was easily dissected free from its pocket. The catheter was then withdrawn a bit from the vein. An attempt was made to aspirate and clear the line, and this was not possible. Therefore, we withdrew the catheter from the vein and planned to advance a new catheter directly through the old access site. This was attempted, but we could not advance the catheter through the vein and in fact were not sure we could identify the vein in this location. After careful dissection was carried out, we spoke with the patient, who was awake, and explained that we should go more proximal in the arm and find the vein in a new site to place the catheter. The patient agreed with this.
Intraoperative ultrasound was used to identify the site of the vein more proximally. The skin was marked, local anesthesia was infiltrated, and incision was made over the vein. Dissection was carried down in this area where the vein was identified. It was isolated proximally and distally with Vicryl suture. The catheter was prepared by flushing with heparinized saline. It was introduced into the vein through a venotomy and advanced proximally under fluoroscopic guidance to the superior vena cava. The stiffening sensor wire was withdrawn. The catheter easily aspirated and was flushed with heparinized saline. We used the previous pocket for the port and tunneled the catheter under the skin bridge to the port. The catheter was cut to the appropriate size and was secured to the PassPort in the usual manner.
The port was positioned in the pocket. The incisions were closed with subcutaneous 3-0 Vicryl and subcuticular 5-0 PDS suture. Steri-Strips were applied to the incision. The port was accessed with a Huber needle and easily aspirated and was flushed with heparinized saline. The incisions were closed with Steri-Strips. Dry dressings were applied. The catheter was secured with a dry gauze bandage holding it in place. This was a 1 inch Huber needle, as we did not have a 1/2 inch available. The patient tolerated the procedure well and was returned to her room in good condition.
