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Insertion of Double-Lumen Hemodialysis Catheter Sample

DATE OF OPERATION:  MM/DD/YYYY

PREOPERATIVE DIAGNOSIS:
Renal failure.

POSTOPERATIVE DIAGNOSIS:
Renal failure.

OPERATION PERFORMED:
Insertion of double-lumen permanent hemodialysis catheter via right internal jugular vein under fluoroscopic guidance.

SURGEON:  John Doe, MD

ASSISTANT:  None.

ANESTHESIA:  IV sedation and local consisting of 36 mL of 1% Xylocaine with epinephrine.

ANESTHESIOLOGIST:  Jane Doe, MD

ESTIMATED BLOOD LOSS:  100 mL.

SPECIMENS:  None.

DESCRIPTION OF OPERATION:  After adequate IV sedation, the patient's right neck and chest area were thoroughly prepped and draped in the usual manner.  The right posterior sternocleidomastoid region area was infiltrated with local anesthetic.  The patient was placed in a slight Trendelenburg position.

The right internal jugular vein was cannulated using an 18 gauge needle.  After one stick, good venous blood flow was aspirated in the syringe and the syringe was removed.  Then, the guidewire was inserted into the needle.  Advancement of the guidewire to the superior vena cava was visualized using the fluoroscope.  The needle was removed leaving the guidewire protruding to the skin.

Next, a 1 cm skin incision at the level where the guidewire was protruding was performed using a #15 blade.  This was carried through the deep and subcutaneous tissue.  Next, the tract for the hemodialysis catheter was delineated with a skin marker all the way to the anterior chest wall.  This area of skin was infiltrated with local anesthetic.

After adequate local anesthesia, a 1 cm skin incision in the anterior chest wall was performed where this dialysis catheter will be exiting.  I then tunneled the double-lumen Split Stream hemodialysis catheter from the neck incision up to the chest wall incision.

Next, using vein dilators, the tract in the neck going toward the internal jugular was dilated with the vein dilator.  This vein dilator was removed and the vein dilator with the peel-away introducer over it was inserted over the guidewire, advanced over the guidewire into the right internal jugular while visualizing with the fluoroscope.  The guidewire and the dilator were removed leaving the peel-away introducer in the lumen of the vessel.

The double-lumen Split Stream catheter was split up to the designated mark, and this was inserted into the lumen of the peel-away introducer.  This was inserted all the way.  The peel-away introducer was removed leaving the dialysis catheter in the lumen of the vessel with the tip terminating in the superior vena cava as visualized with the fluoroscope.  The neck incision was then closed using 4-0 Vicryl in subcuticular fashion.

This dialysis catheter has a nice curve going down towards the chest.  There was good flow of blood through each port of the dialysis catheter.  This was flushed with heparinized solution.  Then, each catheter was flushed with 1000 units of heparin.

Next, 3 mL was instilled in each catheter lumen.  Dialysis catheter was anchored to the skin using the provided butterfly attachment and sutured using 2-0 nylon suture.  Sterile dressings were then applied.  The patient tolerated the procedure well.  The stat portable chest x-ray was ordered.