DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Lumbar radiculopathy, status post subcutaneous programmable infusion pump implant, subcutaneous programmable valve infusion pump battery depletion.
POSTOPERATIVE DIAGNOSIS: Lumbar radiculopathy, status post subcutaneous programmable infusion pump implant, subcutaneous programmable valve infusion pump battery depletion.
PROCEDURE PERFORMED: Removal and replacement of subcutaneous programmable infusion pump, programming subcutaneous programmable valve infusion pump, intrathecal catheter revision.
SURGEON: John Doe, MD
ANESTHESIA: General.
ANESTHESIOLOGIST: Jane Doe, MD
FLUIDS: Crystalloids 600 mL.
ESTIMATED BLOOD LOSS: Zero.
DESCRIPTION OF PROCEDURE: The patient was brought to the OR with an IV running well. The patient was placed in the supine position on the operating room table and placed under general anesthesia without complications. All pressure points were checked and padded. The operation site was squared off with 10 x 10 drapes. The patient was prepped with DuraPrep and draped in a surgical sterile fashion. An Ioban drape was placed over the operation site. Bupivacaine 0.5% with epinephrine 1:200,000, 8 mL, was used to infiltrate the incision site.
A #15 blade was used to make a left abdominal incision 12 cm in length. Dissection down to the subcutaneous programmable infusion pump pocket was made using electrocautery. Electrocautery was used throughout the case for hemostasis. The pump was identified and withdrawn from the pocket.
The proximal catheter connector had a fracture over approximately one third of the circumference with calcification of the intrathecal medications. A Medtronic sutureless pump connector revision kit was used, and the proximal tip was trimmed to equal the length of the new sutureless pump connector. There was positive CSF flow through the intrathecal catheter. This was connected to the sutureless pump connector and covered with a Silastic boot.
The sutureless pump connector was connected to the Medtronic SynchroMed II subcutaneous programmable infusion pump. After the pump was prepped per company protocols and filled with 10 mL of Dilaudid preservative-free 40 mg/mL, which was removed from the patient’s old pump, the pump appeared to be functioning appropriately prior to connection to the intrathecal catheter.
The wound was copiously irrigated with bacitracin irrigation. The scar tissue was removed using electrocautery within the pocket. The pump was placed into the abdominal pocked and secured with a 3-0 silk suture using the suture loops. The wound was copiously irrigated with bacitracin irrigation. Deep layers were closed with 3-0 dyed Vicryl simple stitches. The superficial layer was closed with 3-0 dyed Vicryl in simple running stitch. The skin was closed with surgical staples.
Bacitracin ointment, fluffs, and foam tape were placed as dressings. The patient was placed in an abdominal binder. The patient was taken to the recovery room in good condition. Sponge and needle counts were correct x2. The patient’s pump was programmed to deliver 15 mg per day of Dilaudid.
