Patient Name:Rebecca Boleware
Date of Admission: May 15, 2013
SURGEON: Robert Aultman
PREOPERATIVE DIAGNOSIS: Large cell on differentiate carcinoma of the right lung. POSTOPERATIVE DIAGNOSIS: Large cell on differentiate carcinoma of the right lung. PROCEDURE: Insertion of double ended gross on catheter via left subclavian vein. ANSETHSIA: Local, 1% Xylocaine.
PROCEDURE IN DETAIL:With the patient in the supine position after adequate prepping and draping of the left supraclavicular infraclavicular areas at 18-gauge needle was inserted in the left subclavian vein. A guide wire was passed through the needle and directed into the right atrium under fluoroscopy. The needle was removed and the incision was made in encompassing the puncture site. The dilator and introducer were passed over the wire. The wire and the dilator were removed and the catheter was threaded through the introducer into the upper portion of the right atrium. Using tunneler than a tunnel was made to a chosen exit site. We had placed a red dot in the general vicinity of the exit site. The catheter was threaded on the tunneler and pulled through the subcutaneous tunnel and out the exit site. The syringe adapters were placed on each tubing and secured with the locking sleeve. Blood could be aspirated and instill through each one easily. Each channel was flushed with heparin solution 100 units per cubic centimeter. A butterfly sleeve was placed on the catheter just distal to the exit site and it was secured to the skin with 2-0 silk sutures. The catheter was secured to the sleeve with a 2-0 silk tie. The course of the catheter was under fluoroscopy showed no evidence of caking. The look also appeared expanded the infraclavicular incision was clothed with interrupted 0 silk suture. Addressing was applied. The patient tolerated the procedure well and was sent to the recovery room in stable condition.
Robert Aultman, MD