DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Infected Port-A-Cath.
2. Unresectable cancer of the pancreas.
POSTOPERATIVE DIAGNOSES:
1. Infected Port-A-Cath.
2. Unresectable cancer of the pancreas.
PROCEDURE PERFORMED: Removal of Port-A-Cath.
SURGEON: John Doe, MD
ANESTHESIA: Local anesthesia with sedation by the anesthesia department.
COMPLICATIONS: None.
POSTOPERATIVE CONDITION: To the recovery room in satisfactory condition.
INDICATIONS FOR PROCEDURE: The patient is a (XX)-year-old Hispanic male who has been receiving chemotherapy as treatment for an unresectable cancer of the head of his pancreas. Recently, the patient has developed an elevated white count. Blood cultures have been positive for methicillin-resistant Staphylococcus aureus on several occasions. The patient has not responded to antibiotics. No other source of his infection has been identified. It has therefore been requested that we remove this patient’s Port-A-Cath.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and was placed in the supine position on the operating table. The patient was sedated by the anesthesia department. The patient’s left chest was prepped with DuraPrep. Sterile drapes were applied.
The area of the old incision and over and around the port was infiltrated with 0.5% Carbocaine. The previous incision was excised. Dissection was taken down through the subcutaneous tissues to the level of the port. The capsule of the port was then opened widely. The fibrous tissue over the hub was incised. The sutures holding the port were cut, and the port was removed from the pocket. The tunnel was controlled. The port was then removed. As it came out, a figure-of-eight 3-0 Vicryl suture was placed over the tunnel and tied securely in place. Excess suture was removed.
As the port was infected, the site was not closed. It was packed with 0.5 inch iodoform gauze. Sterile dressing was applied. The patient tolerated the procedure well and was subsequently returned the same day to the recovery room in satisfactory condition.
