DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Non-Hodgkin lymphoma.
POSTOPERATIVE DIAGNOSIS:
Non-Hodgkin lymphoma.
PROCEDURE PERFORMED:
Percutaneous placement of Port-A-Cath via the right subclavian vein.
SURGEON: John Doe, MD
ANESTHESIA: Local using 1% Carbocaine solution with intravenous Versed sedation.
ESTIMATED BLOOD LOSS: 15 mL.
COMPLICATIONS: None.
DETAILS OF PROCEDURE: The patient was transported to the operating room and placed supine on the operating table. Following administration of intravenous Versed to achieve a satisfactory level of anesthesia, the right chest, neck, and supraclavicular fossa were prepped and draped in a customary fashion using Betadine solution and sterile towels and sheets. A site was selected along the right clavicle and the skin thoroughly infiltrated with 1% Carbocaine solution. The right subclavian vein was then easily cannulated and a guidewire introduced using fluoroscopic guidance. Next, the site was selected along the right anterior chest wall for the planned pocket for the Port-A-Cath hub. The skin was thoroughly infiltrated with 1% Carbocaine solution and a transverse skin incision made. The dissection was carried into the subcutaneous tissue and a pocket fashioned using sharp and blunt dissection. All bleeding points were controlled with the Bovie electrocautery. The peel-away introducer was then threaded over the guidewire and the Port-A-Cath tubing introduced into the central venous system. The tip was positioned at the juncture of the superior vena cava and right atrium and this was confirmed with fluoroscopy. The peel-away introducer was then removed and the Port-A-Cath tubing tunneled subcutaneously from the insertion site down to the level of the pocket along the right anterior chest wall. The tubing was trimmed to an appropriate length and then connected to the Port-A-Cath hub. The entire system was flushed with heparinized saline solution and there was found to be good backflow of blood with easy flushing. The hub was secured into the pocket with 2-0 Ethibond sutures and the entire area of dissection thoroughly irrigated with Kantrex solution. After assuring satisfactory hemostasis, the transverse incision was closed with a deep layer of interrupted 3-0 Vicryl sutures followed by running 4-0 Vicryl subcuticular suture for the skin. The insertion site along the right clavicle was closed with a single stitch of 3-0 Vicryl in the subcutaneous tissue. Benzoin and Steri-Strips as well as a Tegaderm dressing were placed across the incisions, and the patient was transported back to the same day surgery area in satisfactory condition with sponge and needle counts reported as correct at the end of the procedure. A chest x-ray was obtained to ensure proper placement of the Port-A-Cath tubing without evidence of pneumothorax.
