DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Rectal cancer.
2. Need for definitive central venous access.
POSTOPERATIVE DIAGNOSES:
1. Rectal cancer.
2. Need for definitive central venous access.
OPERATION PERFORMED:
1. Placement of left subclavian single-lumen Port-A-Cath.
2. Interpretation of fluoroscopy for placement of Port-A-Cath.
SURGEON: John Doe, MD
ANESTHESIA: Local MAC.
ESTIMATED BLOOD LOSS: Minimal.
COMPLICATIONS: None.
POSTPROCEDURE CONDITION: Good.
SPECIMENS: None.
INDICATIONS FOR OPERATION: The patient is an (XX)-year-old gentleman with rectal cancer. He is referred for placement of Port-A-Cath, so he can receive neoadjuvant chemoradiation. We discussed the risks of the procedure, which include perforation, hemothorax, poor bowel function, and infection, as well as alternatives to the procedure. The patient demonstrated understanding and elected to proceed.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed supine on the operating room table. After induction of IV sedation, a towel roll was placed between the scapulas. Both arms were tucked. The patient had previously received IV Ancef. Therefore, the bilateral neck and chest were prepped and draped using DuraPrep and Ioban. Infraclavicular anesthesia was then applied using 1% lidocaine, and the subclavian vein was cannulated on one pass and the wire advanced.
At this point, we had some ventricular ectopy, and therefore, the wire was withdrawn. The position of the wires was then confirmed fluoroscopically and then a small incision was made in the skin with the #11 blade knife, and the dilator and obturator were passed over the wire under direct fluoroscopic vision. The wire and dilator were then removed and the catheter fed into the obturator down into the right ventricle. Again, ectopy was noted, and therefore, the catheter was withdrawn. Then, using a peel-away technique, the obturator was removed.
The catheter was then aspirated with good blood return and flushed with heparinized saline. At this point, additional local anesthetic was used to anesthetize an area around the insertion site and then a knife was used to make a 4 cm incision and a pocket was created using cautery. The pocket was located just above the pectoralis fascia. The area was then flushed with Kantrex and saline, and hemostasis was obtained. The port was checked and noted to fit nicely within the pocket. At this point, the catheter hub was placed. The catheter was cut to length after confirming the tip in the superior vena cava and then the catheter was attached to the port and the hub secured, clicking into place. The port was then placed in the pocket, and the catheter was noted to have no kinking.
Fluoroscopic assessment demonstrated normal positioning of the catheter in the superior vena cava. In addition, there was no evidence of kinking of the catheter. A Huber needle was then used to access the port and aspirated and noted to have good blood return. The port was then flushed and noted to flush easily. The hub was then secured using two 2-0 Prolene sutures. The port pocket was then thoroughly irrigated with Kantrex and saline and then the skin incision was closed using interrupted 3-0 Vicryls in the dermis and running subcuticular 4-0 Vicryl in the skin. Benzoin and Steri-Strips were applied and then a dressing and Tegaderm dressing were applied. The patient tolerated the procedure well and was taken to recovery in good condition.
