DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Renal failure with developing hematoma in the left arm, now needing access for hemodialysis.
POSTOPERATIVE DIAGNOSIS: Renal failure with developing hematoma in the left arm, now needing access for hemodialysis.
OPERATION PERFORMED: Right internal jugular Permacath placement.
SURGEON: John Doe, MD
ANESTHESIA: IV sedation.
COMPLICATIONS: None.
EBL: Minimal
CONDITION: Stable.
FINDINGS: There is a very laterally positioned internal jugular vein.
DESCRIPTION OF PROCEDURE: After informed consent was obtained, the patient was taken to the OR and prepped and draped in a sterile fashion. The right IJ was identified with ultrasound; again, appeared to be very, very lateral. This was accessed with a large bore needle and a wire was inserted and manipulated the SVC-right atrial junction. Next, the tract was then sterilely dilated. Finally, the introducer sheath was advanced over the wire under fluoroscopic guidance. The catheter tip was in position in the right atrium. The catheter was then brought through a retrograde and subcutaneous tunnel through the right chest. The catheter was then fully assembled. Each of the two lumen were aspirated with good blood return and flushed with heparinized saline solution. The catheter was secured in place with 3-0 nylon. The incision was approximated with 4-0 Vicryl stitches. Sterile dressing was applied. The patient was returned to recovery in stable condition.
DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Renal failure.
POSTOPERATIVE DIAGNOSIS: Renal failure.
OPERATION PERFORMED: Insertion right internal jugular Permacath.
SURGEON: John Doe, MD
DESCRIPTION OF PROCEDURE: The patient was prepped with Betadine and draped with routine sterile drapes. A right internal jugular venipuncture was done without difficulty. Guidewire was advanced into the right atrium under C-arm guidance. Tunnel was then developed, and the dilator and sheath were then passed. Dilator wire was removed. The catheter was advanced to the atrium and the sheath was removed. Hemostasis was obtained. The catheter was aspirated and filled with saline and heparin. The catheter was sutured in place with 3-0 nylon, and the neck wound was closed with 3-0 nylon. Dressings were applied. The patient tolerated the procedure well with approximately 5 cc of blood loss. Sponge, needle, and instrument counts were correct. The patient was sent to the recovery area in excellent condition.
DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Renal failure, need for dialysis access.
POSTOPERATIVE DIAGNOSIS: Renal failure, need for dialysis access.
OPERATION PERFORMED: Left subclavian Permacath placement.
ASSISTANT: None.
ANESTHESIA: IV sedation with 18 mL of 0.5% Xylocaine with epinephrine for local analgesia.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and placed in a supine position whereupon a blood pressure cuff, EKG leads, and O2 monitor were placed. After administrating adequate IV sedation, the patient was prepped and draped in a sterile fashion. The patient received preoperative antibiotics and had sequential compression devices on. The patient had a total of 18 mL 0.5% Xylocaine with epinephrine for local analgesia in the left subclavicular area. Using Seldinger technique, the subclavian vein was entered, and the superior vena cava was cannulated with a guidewire. This was confirmed with fluoroscopy. A separate stab wound was made inferior and lateral to the insertion site and a tunnel was created. The 23 cm dialysis catheter was tunneled through this area and then advanced into the superior vena cava via guidewire sheath apparatus. Both insertion site and secondary incision site were closed with subcuticular 4-0 Vicryl in an interrupted fashion. Sterile dressing was applied. The Quinton Permacath had excellent blood return. Both ports were flushed with half saline solution. The patient was taken to the postanesthesia care in stable condition. There were no immediate complications, and x-ray will be obtained.
NOTE: PermCath is the preferred and correct word, though Permacath can also be found in reference sources. Go with PermCath if no specific request for “Permacath” is made by the doctor.
