Using a 16-gauge needle, the left subclavian vein was cannulized so that the wire would not spread down to the superior vena cava. After several manipulations, the procedure was aborted and the procedure was then turned to the right IJ. The right IJ area was anesthetized with the same local. The needle was then introduced into the right internal jugular vein. The wire was then passed down to the superior vena cava without difficulty under direct fluoroscopy. Following that, the area of the right chest was anesthetized.
A small incision was made approximately 2 inches to the left with the scalpel and further carried down with electrocautery. A pocket was made over the left chest with a blunt dissection. Port was placed into the pocket. The dilator and sheath were then placed over the wire using fluoroscopy into the superior vena cava. Next, the catheter was then tunneled from the chest site to the puncture site with the use of a tunneling device and the kit. The catheter was then cut to size with the use of fluoroscopy. The wire and dilator were then removed leaving the sheath intact. The catheter was then thread down the sheath. The sheath was then removed. With fluoroscopy, the catheter was then checked. It was noted to be in the superior vena cava just above the right atrium. There seemed to be good adequate blood, which rolled from the port and flushed easily. The port was then sutured in place with 0 Vicryl to the fascia in the anterior chest wall.
The subcutaneous tissue of the pocket was then approximated with 3-0 Vicryl interrupted. The skin was approximated with 4-0 Monocryl running subcuticular. The puncture site was closed with a single stitch of 4-0 Monocryl in an interrupted fashion. The area of the chest and neck was cleaned and dried. Benzoin was applied to the incision site and Steri-Strips were applied. The port was then flushed with heparin 1000 units per mL, 2 mL used. The patient was sent to the recovery room in alert, awake and stable condition. All sponge and instrument counts were correct at the end of the case. A stat chest x-ray was ordered in the recovery room.
