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PermCath Insertion Procedure Transcription Sample Report

DATE OF PROCEDURE:  MM/DD/YYYY

PREOPERATIVE DIAGNOSIS:
Chronic renal failure.

POSTOPERATIVE DIAGNOSIS:
Chronic renal failure.

PROCEDURES PERFORMED:
1.  Insertion of left internal jugular PermCath under ultrasound and fluoroscopy guidance.
2.  Creation of right brachiocephalic fistula.

SURGEON:  John Doe, MD

CLINICAL FINDINGS AND INDICATIONS FOR PROCEDURE:  This (XX)-year-old female with chronic failure presented for insertion of acute and chronic vascular access. The left internal jugular vein was accessed under ultrasound guidance and a tunneled 23 Arrow catheter was placed at the superior vena cava and right atrial junction. A right brachiocephalic fistula was created between the cephalic vein and the brachial artery.

DESCRIPTION OF PROCEDURE:  The patient's neck was prepped and draped in the usual manner. The area was scanned with an ultrasound, and the right internal jugular vein was seen. This area was infiltrated with Carbocaine 1%. Then, under ultrasound guidance, the vein was accessed with a single percutaneous stick. A guidewire was introduced, and under fluoroscopy, a sheath and dilator were placed. A 23 Arrow catheter was placed at the superior vena cava and right atrial junction. The catheter was pulled through the anterior chest wall and transected. The attachment was placed. The catheter was sutured to the skin with 3-0 Prolene. The tunneled catheter was closed with 4-0 Maxon.

Attention was directed to the right arm, where an incision was taken down through the skin and subcutaneous tissue to the antecubital fossa, where the cephalic vein was isolated by blunt and sharp dissection. The collaterals, including superficial cephalic and deep cephalic, were ligated with 2-0 silk and oversewn with 3-0 Prolene. This was mobilized medially and was distended with 3 and 4 mm dilator. The brachial artery was found below the fascia proximal and distal to the brachial artery, and arteriotomy was made. End-to-side anastomosis was fashioned with continuous 6-0 Prolene suture for the posterior wall and interrupted 6-0 for anterior wall.

Upon releasing the clamps, a palpable thrill was obtained. The incision was closed in layers, subcutaneous with 2-0 PDS and subcuticular 4-0 Monocryl. Steri-Strips were applied. The patient left the OR in good condition.

DATE OF PROCEDURE:  MM/DD/YYYY

PREOPERATIVE DIAGNOSES:
1.  Morbid obesity.
2.  Infected venous aneurysm.
3.  Left upper arm brachiocephalic fistula.

POSTOPERATIVE DIAGNOSES:
1.  Morbid obesity.
2.  Infected venous aneurysm.
3.  Left upper arm brachiocephalic fistula.

PROCEDURES PERFORMED:
1.  Closure of left brachiocephalic fistula.
2.  Excision of venous aneurysm.
3.  Insertion of left internal jugular PermCath.

SURGEON:  John Doe, MD

DESCRIPTION OF PROCEDURE:  The patient's neck was prepped and shaved in the usual manner. The skin was infiltrated with Carbocaine 1%. The left internal jugular vein was accessed by percutaneous ultrasound. A guidewire was inserted with some difficulty in the superior vena cava, but had to be manipulated several times. Following the sheath and dilator, a 27 Arrow was placed in right atrial junction. The catheter was pulled and tunneled on the anterior chest wall. Attachment was placed. Checked for inflow and outflow and performed well. The catheter was fastened to the skin with 3-0 Prolene.

Attention was directed to the left upper arm. At this time, her arm was addressed by an incision through the skin and subcutaneous tissue to the antecubital fossa down to the anastomosis to the cephalic and brachial vein. The vein was clamped, ligated and transected, double ligated with 2-0 silk and oversewn with 5-0 Prolene. The venous aneurysm was excised by means of blunt and sharp dissection. This was a size of a lemon. The venous limb was double ligated with 2-0 silk suture and suture ligated with 4-0 nylon. Then the aneurysm was dissected first around the tissues by means of sharp dissection.

Bleeders were clamped and aneurysm was excised. The bleeding area of the aneurysm was addressed by taking an ellipse out of the perforation, which was very close to the skin. It was closed with a running locking 3-0 Prolene. The incision then was closed with vertical mattress sutures of 4-0 nylon. A pressure dressing was placed. The patient left the OR in stable condition.