DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Recurrent non-Hodgkin lymphoma.
2. Poor intravenous access.
POSTOPERATIVE DIAGNOSES:
1. Recurrent non-Hodgkin lymphoma.
2. Poor intravenous access.
PROCEDURE PERFORMED: Right subclavian vein NeoStar catheter placement.
SURGEON: John Doe, MD
ANESTHESIA: MAC with 20 mL of 0.5% Marcaine with epinephrine.
ESTIMATED BLOOD LOSS: Minimal.
SPECIMENS: None.
DRAINS: None.
COMPLICATIONS: None.
INTRAOPERATIVE FINDINGS: Using directed fluoroscopy, a right subclavian NeoStar catheter was placed at the SVC-right atrial junction measuring 24 cm from the path of the catheter.
INDICATIONS FOR PROCEDURE: The patient is a (XX)-year-old female who has had a history of breast cancer as well non-Hodgkin lymphoma. She has now had a recurrence of her lymphoma and is in need of a NeoStar catheter for a stem cell harvest. She was explained the risks and benefits of the placement of the catheter, including infection, bleeding, and pneumothorax and wished to proceed.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and placed in supine position on the operating room table. A roll was then placed between her shoulder blades. Her upper extremities were then restrained using self-restraints. She was then placed under state of IV sedation and prepped and draped in a standard surgical fashion using DuraPrep.
After being prepped and draped, attention was then turned to the right chest, which was then anesthetized using 0.5% Marcaine with epinephrine. A large-bore needle was then used to access the right subclavian vein. This was accomplished on the first attempt. Guidewire was passed easily and was confirmed under fluoroscopy.
The catheter was then tunneled from an inferior incision to the venipuncture site. It was then cut to fit at approximately 24 cm. The dilator introducers were then passed over the guidewire using the Seldinger technique. There appeared to be scarring at the head of the clavicle, which was dilated up. The catheter was then placed into the introducer and was found to be somewhat restricted in passing; therefore, a Glidewire was passed down the catheter. The introducer was peeled away, and the catheter was then positioned under direct visualization at the junction of SVC, right atrium. Guidewire was then removed.
All three ports flushed and aspirated easily. The catheter was then sutured into place using 2-0 Prolene x2. The venipuncture site was closed using 4-0 Monocryl in a simple interrupted subcuticular stitch. The wounds were washed and dried. Steri-Strips, sterile dressing, and Tegaderm were applied. The patient tolerated the procedure well, was awakened in the operating room, and transferred to the PACU in good condition. All sponge, needle, and instrument counts were correct at the end of the case.
