CLINICAL INDICATIONS:
This patient needs long-term vascular venous
access for chemotherapy and has chosen a *right/left chest port.
PROCEDURE:
The patient was brought to the Operating Room
and prepped and draped in the usual manner. Under local infiltrative anesthesia with IV
sedation, an approach was made to the internal jugular vein. Using ultrasound control
and micropuncture technique on the *right/left side, a 0.018 wire was placed in the right
heart and confirmed by the fluoroscope. The micropuncture system was used to convert
the 0.018 wire to a 0.035 wire. A site was selected on the anterior chest wall for the port
pocket and the port pocket was made. From this pocket to the neck incision, a tunnel
was made for the catheter. The catheter was brought through the tunnel and attached to
the port. The port was placed into the premade pocket. The catheter was now measured
to length using the fluoroscope. A dilator and sheath were passed over the wire under
real-time fluoroscopy. The dilator and wire were removed. The catheter was placed
through the pull-away sheath and the sheath pulled away. The fluoroscope showed the
tip of the catheter was at the junction of the superior vena cava and right atrium. Once
this was determined, the port was sutured in place with a 3-0 Dexon, the pocket closed
with 3-0 Dexon, and the skin with 4-0 Dexon subcuticular in both locations. Sterile
dressings were applied. The port was tested for function and worked well. The patient
tolerated the procedure well.