ASSISTANT:
ANESTHESIOLOGIST:
PREOPERATIVE DIAGNOSIS: The patient needs long-term
vascular access because of difficulty obtaining peripheral
lines.
POSTOPERATIVE DIAGNOSIS: The patient needs long-term
vascular access because of difficulty obtaining peripheral
lines.
OPERATION:
1.
Fluoroscopic guided central venous catheter (PICC
line) placement with the catheter tip in the superior vena
cava/right atrial junction.
2.
Ultrasound guidance for evaluation of the upper
extremity veins and for vascular access.
ANESTHESIA: Local anesthesia with 1% Lidocaine solution
was utilized in the subcutaneous and subcuticular tissues.
No intravenous sedation was given.
TECHNIQUE: After obtaining an informed verbal and written
consent, the patient was prepped and draped in the usual
sterile fashion over the upper arm area. With the use of
an ultrasound, the area of the upper arm was evaluated in a
limited fashion. Basilic vein, cephalic vein and brachial
vessels were evaluated under real time ultrasound. The
probe was covered with a sterile covering. The * vein was
chosen as the most suitable vessel for vascular access.
With the use of real time ultrasound guidance, the area
over the vein was anesthetized with 1% Lidocaine solution
in the subcutaneous and subcuticular tissues. Access was
gained to the vein with the use of real time ultrasound
guidance. Over the 0.018 guidewire provided with the
Meditech PICC line set, the peel-away dilator sheath
combination was introduced into this vein. The length to
the superior vena cava/right atrial junction was measured
to be * cm. The catheter was cut to the desired length and
placed with its tip in the superior vena cava/right atrial
junction. The catheter was secured to the skin with
sutures.
Antibiotic ointment was also applied and a Tegaderm was
applied on top of the catheter exit site. The catheter was
flushed with heparinized saline.
immediately.
SPECIMENS TO PATHOLOGY:
ESTIMATED BLOOD LOSS:
The catheter may be used
None.
Less than 5 cc.
IMPRESSION: Successful placement of a * lumen PICC line
catheter with the catheter tip in the superior vena
cava/right atrial junction. The catheter length is * cm.
The catheter was placed on the * side.