DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Crohn disease and short bowel syndrome with need for long-term venous access for continued home total parenteral nutrition.
POSTOPERATIVE DIAGNOSIS:
Crohn disease and short bowel syndrome with need for long-term venous access for continued home total parenteral nutrition.
PROCEDURE PERFORMED:
Placement of left subclavian single-lumen Hickman catheter.
SURGEON: John Doe, MD
ANESTHESIA: Local MAC with 70 mL of 0.5% Carbocaine.
COMPLICATIONS: None apparent.
DISPOSITION: To the same day surgery area.
INDICATIONS FOR PROCEDURE: This is a patient with a longstanding history of short bowel syndrome secondary to Crohn disease, who has had multiple prior Port-A-Cath and PICC line, who has developed recurrent complications with infected PICC line as well as chronic DVT in his upper extremities. The patient now comes in for placement of a new Hickman catheter.
DESCRIPTION OF PROCEDURE: The patient was placed on the operating table in the supine position, and intravenous sedation was administered. A rolled blanket was placed behind his upper spine to the base of his neck and to the lumbar region in the longitudinal fashion. Both arms were tucked by his side and positioned in Trendelenburg position. The patient was prepped from his chin down to his mid abdomen and from side to side with ChloraPrep. The patient was draped with paper drapes, cloth towels, Ioban, and paper laparotomy sheet. Prior to starting, a timeout was taken to confirm that the patient was correct. Antibiotics had been given, and the patient was prepared to begin.
An attempt was made to cannulate the right internal jugular vein without success. There was one passage of the small needle into the carotid artery. Low pressure was applied without any further complication. Attention was then directed to the left subclavian region, which was anesthetized with 0.5% Carbocaine, and the subclavian vein was cannulated on the second pass. Guidewire was passed under fluoroscopic guidance. The guidewire initially went up into the neck, which was manipulated under fluoroscopy down into the superior vena cava and into the right atrium.
The Hickman catheter was placed through the tunnel in the anterior chest after the tunnel had been anesthetized with 0.5% Carbocaine and peel-away sheath was placed over the guidewire under direct fluoroscopic guidance, and the catheter was passed through the peel-away sheath and positioned with the tip of the catheter in the proximal right atrium.
Upon completion of the placement of the catheter, the incision of the subclavian area was closed with single 3-0 Vicryl horizontal mattresses suture, and the skin was approximated with Dermabond dermal adhesive. The catheter was secured to the skin at selected point with 4-0 stainless steel sutures. A central line dressing kit was placed around the catheter. The patient was transferred to the same day surgery area in stable condition, where an upright chest x-ray revealed the tip of the catheter to be in good condition and no evidence of complicating factors such as pneumothorax or hemothorax.
All sponge, needle, and instrument counts at the conclusion of the procedure were reported as correct by the nurses.
