Surgery
Double Lumen Port-a-Catheter
PREOPERATIVE DIAGNOSIS: Colon cancer and question bladder cancer.
POSTOPERATIVE DIAGNOSIS: Same.
PROCEDURE: Placement of double lumen port-a-catheter left subclavian vein.
SURGEON: Dr. G.
ANESTHESIA: General.
DETAILS OF THE PROCEDURE: Patient was brought to the Operating Room by Dr. W, where he underwent cystoscopy and biopsy of bladder tumor. At the conclusion of that procedure, the patient remained intubated and the left chest area were prepped and draped in the usual fashion. The introducer needle was passed into the subclavian vein on the first attempt, with the patient in Trendelenburg. The guidewire was advanced under fluoroscopic control, then a pocket was created lower down on the chest wall by incising the skin with a knife and creating the deep subcutaneous pocket with the electrocautery devise. The pocket was irrigated and then the catheter was brought through a subcutaneous tunnel so that the port hub lay comfortably in the pocket and the catheter was brought out through the guidewire introducer site. The catheter was trimmed to length and the dilator and parotid sheath were advanced over the guidewire again with the patient in Trendelenburg. The parotid sheath was then subsequently removed and again fluoroscopy was used to confirm that the catheter was in good position in the superior vena cava. The catheter was noted to flush easily through both ports. Blood could be aspirated easily as well. The ports were flushed with heparinized saline, followed by straight heparin, 1,000 units per cc, 1 cc in each port. The pocket was again irrigated and then closed in layers using 3-0 Vicryl and 4-0 Monocryl suture. Steri-Strips and sterile dressings were applied. The patient was extubated in the Operating Room and transferred to the Recovery Room in satisfactory condition.
COMPLICATIONS: None.