DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Dysfunctional dialysis catheter.
PROCEDURE PERFORMED:
1. Removal of the dysfunctional catheter.
2. Insertion of a new Tesio catheter system for long-term hemodialysis.
SURGEON: John Doe, MD
ANESTHESIA: IV sedation.
ANESTHESIOLOGIST: Jane Doe, MD
DESCRIPTION OF PROCEDURE: With the patient in the supine position and following IV sedation, the neck and anterior chest were prepped with Betadine scrub and Betadine solution, and the patient was draped in the usual manner with sterile surgical drapes. This patient had a Tesio catheter inserted. He went to dialysis. It was not functioning. It was checked in the emergency department and was unable to flush the catheter. We removed the catheter partially at that time, and the patient was scheduled to return to the operating theater today.
At the time of this operative procedure, it was necessary to insert a new system rather than just changing one catheter. Incisions had been made over the Teflon pledgets and had been dissected free of the surrounding adventitial tissues. After the catheters had been removed, the subclavian vein was recannulated twice with 18-gauge trocar needles. A wire was passed through these trocar needles into the superior vena cava.
Following this, vascular dilator and introducer sheaths were passed over the guidewire. Next, two Tesio catheters, one passed through one introducer sheath and the second was passed through the second introducer sheath. We positioned the catheters near the right atrium under fluoroscopy. Following this, the catheter was attached to tunneling stylets, which were passed through the subcutaneous tissues and exited on the anterior chest.
Compression washer and nuts were placed on each one of these catheters. The appropriate adaptors, the red on the red catheter and the blue on the blue catheter, were positioned within the catheter, and they were secured in place with compression washer and nut. We aspirated through each of these catheters. There was good backflow of blood from both. They flushed easily forward.
At this point, the catheters were secured to the skin. The chest wounds were approximated with interrupted sutures of 4-0 chromic suture. It was verified that the catheters were in good place. The plan will be to obtain a chest x-ray to confirm the position. The patient will be going to dialysis.
