PGDIACATH
CLINICAL INDICATION: Renal failure
PROCEDURE: Ultrasound and fluoroscopic-guided right internal jugular tunneled hemodialysis
catheter insertion.
PHYSICIAN: Dr. Paul Gryzenia
MEDICATIONS: Subcutaneous 2% lidocaine, 0.5 mg Versed, 25 mcg fentanyl, and 1 gram of
Ancef for antibiotic coverage
COMPLICATIONS: None immediate
RADIOLOGIST INTRASERVICE TIME/CONSCIOUS SEDATION TIME: _ minutes. The patient
was monitored throughout the procedure by the IR nurse. I was personally present in the above
mentioned conscious sedation time.
FLUORO TIME: _ minutes.
PROCEDURE AND TECHNIQUE: After discussing the risks and benefits of the procedure with
the patient, oral and written consent was obtained.
The patient was placed in a supine position on the fluoroscopy table. The right neck and upper
chest were then prepped utilizing maximum sterile barrier technique. The skin was subsequently
anesthetized with 2% lidocaine.
The _ internal jugular vein was patent and compressible. A stored sonographic image was
obtained.
Under direct sonographic guidance, the right internal jugular vein was accessed with a 22-gauge
microaccess needle with the aid of a 0.018 inch wire. The wire was advanced into the right
atrium and the needle was exchanged for a 5-French microaccess sheath. Through this, a 0.035
inch 3J wire was advanced into the inferior vena cava. A track was then serially dilated to 14French. A tunnel was then created from a small incision site along the right lateral aspect of the
chest to the venotomy site after the administration of 2% lidocaine. The catheter was
subsequently pulled through the tunnel and advanced through a peel-away sheath under
suspended respiration into the right atrium. The peel-away sheath was removed and the distal tip
of the catheter was identified at the level of the atriocaval junction.
The catheter aspirated and flushed well. The venotomy was closed with a single 3-0 silk suture
and the catheter was secured through its tunnel with a single purse string suture.
Both lumens were then flushed with heparin flush (1000 units per cc).
The patient tolerated the procedure well without immediate complication.
The final fluoroscopic image demonstrates the distal tip of the catheter at the level of the
atriocaval junction. The catheter is ready for use.
IMPRESSION:
 Successful insertion of a right IJ tunneled hemodialysis catheter with distal tip at the level
of the atriocaval junction.
 The catheter is ready for use.