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IR Dialysis Catheter

Indication: [<65 year old man presented with MOSF, nephrology has determined patient unlikely to recover renal function and will now be dialysis dependent.>] Needs permanent HD catheter placement. Procedure: 1. Ultrasound of the [[ neck. 2. Ultrasound with fluoroscopic guided access of the [] internal jugular vein. 3. Insertion of a 23 cm tip to cut, 14.5F hemodialysis catheter via the [] IJ vein. Physicians: Ching, Osadsky. Medications: 1. 50 mcg fentanyl IV. 2. Local 1% lidocaine. Complications: None. Operative note: Following oral and written informed consent, the patient was placed in the supine position on the angiography table. Ultrasound was used to scan the neck to confirm patency of the [] internal jugular vein. The neck and upper chest were then prepared and draped in standard sterile fashion. Access was gained into the [] internal jugular vein using ultrasound guidance and a micropuncture set. The needle was observed under ultrasound to enter the vein which was noted to be patent. Imaging of the ultrasound-guided access was sent to the PACS system for the patient's permanent medical record. Access was secured with an 0.035 J guidewire. Following the administration of 1% lidocaine, a subcutaneous tunnel was then created from the anterior chest wall and the catheter was brought through the subcutaneous tunnel using a tunneling device. The [] neck venotomy was then dilated in a stepwise fashion. A peel-away sheath was placed in the [] internal jugular vein. The catheter was then advanced through the peel-away sheath to the atriocaval junction after removal of the wire and dilator. The catheter was then advanced through the peel-away to the atriocaval junction. The catheter was flushed with saline and heparin and secured in place. The venotomy site was closed with Dermabond. A sterile dressing was applied. The patient tolerated the procedure well and was transferred back to the ward in stable condition. No immediate complications were identified. Findings: 1. The tip of the 23 cm, 14.5 French hemodialysis catheter is at the cavoatrial junction. 2. The catheter flow rates are greater than 600 mL per minute. Each port was locked with 5000 units heparin. Impression: Successful placement of a tunneled hemodialysis catheter via the [] internal jugular vein. Plan: 1. Standard postprocedure recovery and catheter care. 2. The hemodialysis catheter is ready for use.