WSHIMA: Case # 16: Dialysis Catheter Insertion
Preoperative diagnosis: End stage renal disease with clotted access.Thrombosis dialysis catheter.
Postoperative diagnosis: Same
PROCEDURE PERFORMED:
- Right internal jugular vein ultrasound-guided cannulation.
- Right internal jugular vein tunneled dialysis catheter insertion with fluoroscopic guidance.
IMPLANTS: 28cm Tunneled dialysis catheter
CONTRAST: IOPAMIDOL
INDICATION FOR THE PROCEDURE: pt. is 78 y.o. male who is admitted with ESRD and thrombosis in dialysis catheter for placement tunneled dialysis catheter.
FINDINGS: Right internal jugular vein was of adequate caliber and no thrombus was present. The tunneled catheter placement was satisfactory and there was no kinking in the line. The line drew and flushed easily.
DESCRIPTION OF PROCEDURE: The patient was brought into the angio suite and placed in the supine position. The pre-procedure surgical pause was observed and identity was confirmed along with allergies and proposed procedure.
The right neck and chest were prepped and draped in the usual sterile fashion. Ultrasound was used to evaluate the right internal jugular vein for access and the vein was noted to be adequate and without thrombus. Access to the vein was obtained with micropuncture kit under ultrasound guidance. An image of the needle entry into the vein was captured and placed in the patient's chart.An skin nick at the access site was made and the sheath was introduced. A 4 Fr sheath was then placed and a guide wire was advanced under fluoroscopic guidance to the superior vena cava.
An incision was made in the chest and the catheter was tunneled subcutaneously into the incision at the access site. The micropuncture sheath was removed, the tract was dilated with serial dilators, and peel-away sheath was inserted over the wire, and the wire and the inner dilator were removed and the catheter was inserted through the peel-away sheath. The peel-away sheath was removed.
The dialysis catheter was confirmed to be in good location with the tip of the catheter positioned at the cavoatrial junction with fluoroscopic guidance. The exit site of the catheter and the catheter was secured with 3.0 nylon suture and the neck incision was closed with 4-0 vicryl suture and the ports were flushed with heparinized saline. Spot film confirmed satisfactory catheter placement. Dressings were applied to the catheter exit site at the chest.