PREOPERATIVE DIAGNOSIS: Renal failure requiring dialysis.
POSTOPERATIVE DIAGNOSIS: Renal failure requiring dialysis.
Right internal jugular vein PermCath placement.
Peritoneal dialysis catheter placement.
DESCRIPTION OF THE PROCEDURE: The patient was taken to the operating room and placed in the supine position. The patient was administered general endotracheal anesthesia. The patient was then placed in the Trendelenburg position. The patients right neck as well as his abdomen was prepped and he was sterilely draped.
The right internal jugular vein was located with a 22 gauge finder needle. A large needle was then placed in the internal jugular vein and a wire passed easily through the needle and was visualized on fluoroscopy to be in the right ventricle.
An introducer sheath was placed over the wire and a second wire was introduced and again visualized on fluoroscopy. The internal jugular vein was then serially dilated. A Spires PermCath was placed over the wires and was visualized on fluoroscopy to be in the junction of the right atrium and superior vena cava. The catheter was cut and then tunneled to the right anterior chest wall. The catheter aspirated and was flushed with heparinized saline. The catheter was visualized on fluoroscopy to be near the right atrial junction.
The venipuncture site was closed with 4-0 Caprosyn in a subcuticular fashion. The catheter was secured to the skin using a 2-0 Prolene suture. An Op-Site was applied to the catheter and Steri-Strips were applied to the venipuncture site.
The infraumbilical skin was incised and dissection was carried down to the fascia. The fascia was incised and a peritoneal catheter was placed into the peritoneal cavity and directed into the pelvis. The proximal cuff was secured to the fascia with a purse string #0 Vicryl suture. The catheter was then tunneled to the left anterior abdominal wall.
The distal cuff was in a subcutaneous location. The catheter flushed easily.
The dermal tissue was re-approximated with 3-0 Vicryl in running fashion. The skin was closed with 4-0 Caprosyn in a running subcuticular fashion. The wound was infiltrated with 0.5% Marcaine with epinephrine. The patient had Steri-Strips and a sterile dressing applied. The catheter was secured with a dressing and tape.
A postprocedure chest x-ray showed the PermCath to be in the right atrium. The catheter was backed out approximately 2 cm. The patient tolerated the procedure well with no evidence of complication.