[Expert Solution]: LOCATION: Outpatient, Hospital PATIENT:…

LOCATION: Outpatient, Hospital PATIENT: Cynthia Bell PRIMARY PHYSICIAN: George Orbitz, M.D. INTERVENTIONAL RADIOLOGIST: Edward Riddle, M.D. CLINICAL SYMPTOMS: Chronic renal failure. PROCEDURE PERFORMED: Placement of tunneled hemodialysis catheter HISTORY: The patient is a 69-year-old female with a history of renal failure. Dr. Orbitz has requested the placement of a tunneled hemodialysis catheter. Prior to the start of the study, the procedure was explained to the patient, including the risks, complications, and alternatives. The patient understood and consented to the exam. DESCRIPTION OF PROCEDURE: The patient was prepped and draped in the usual sterile fashion. An Ioban II was placed on the skin. Using sterile technique under ultrasound guidance following administration of local anesthesia, a 21-gauge micropuncture needle was advanced into the right internal jugular vein in the lower neck region. Using a microvena kit, a 0.18 stainless steel wire was used to measure the distance from the junction of the right atrium/superior vena cava to the skin site, and the appropriate-sized catheter was obtained. A 5 French straight catheter was advanced into the internal jugular vein. The catheter was then placed to flush. A small skin incision was placed in the upper chest region. Following administration of local anesthesia, a tunnel was obtained between the two skin incisions. A vascular sheath was then placed through the tunnel, and the More-Flow was then advanced through the peel-away sheath. The 5 French straight catheter then was removed over an extra-stiff wire, and a peel-away sheath was placed into the right internal jugular vein. The dilator and wire were then removed, and the end of the peel-away sheath was crimped to avoid blood loss with the patient holding his or her breath. The tip of the catheter then was advanced through the peel-away sheath with the tip at the proximal right atrium. The peel-away sheath was removed, and the catheter was adjusted to obtain a smooth transition. The cuff of the catheter was approximately 1 to 2 cm from the incision site. A single 2-0 Prolene suture was then placed at the catheter insertion site, and two sutures were placed at the lower neck incision site. No obvious bleeding was seen. Contrast was infused through both ports, which revealed adequate placement. The patient tolerated the procedure well. The patient denied pain and shortness of breath at termination of the study. IMPRESSION: Placement of a 14.5-French AngioDynamics More-Flow hemodialysis catheter through the internal jugular vein as described above.