Need help with this. Thanks is advance
Pre-Op/Post Op Diagnosis: Fractured MediPort Catheter
OPERATION: 1. Central venogram with interpretation and unsuccessful attempt at snaring MediPort catheter
2. Left upper extremity ultrasonography with interpretation.
ACCESS: Right common femoral with a 7 French sheath using ultrasound guidance.
CATHETERIZATIONS: 1. Left brachiocephalic vein 2. Right brachiocephalic vein.
FINDINGS: Catheter sits against the wall of the left brachiocephalic vein and could not be snared. I believe that it has been encapsulated by neointima.
PROCEDURE: The patient gave informed consent and was taken to the endovascular lab. She was given sedation and we prepped and draped her groins. We did a timeout. I used the ultrasound to visualize her common femoral vein and injected 1% Lidocaine as a field block The vein was cannulated percutaneously under real time ultrasound guidance. Sheath was secured over a wire and put a 45 cm 7 French sheath up through the heart over the wire to the superior vena cava. I then used a combination of catheters and wires and snares to grab this catheter. I used angled glidecatheter and a Glidewire and then three different snares including the smaller sizes and then the larger 1830 M snare. This was not successful. I then placed an RDC 6 French guiding catheter and used this to torque and change the angle to do different obliquities including lateral views and I could get the snare up against the catheter, but I could never actually grasp it. I could never get all the way around it. I then prepped and draped the left upper extremity and used the ultrasound and tried to get into the basilica vein thinking that I could snare it from a basilica approach. She does not have a basilica vein. She has patent brachial vein, but with an INR of 2.9, I did not feel good about sticking her brachial vein. I tried again from the groin and ultimately decided to stop.
Fluoro time was 20 minutes in total with 1164 milligray and 6645 DAP. The catheter is clearly not in jeopardy of embolization and I am going to recommend leaving it alone. She is taken back to the ICU for her fresh frozen plasma and for sheath removal.
Pre-Op/Post Op Diagnosis: Fractured MediPort Catheter
OPERATION: 1. Central venogram with interpretation and unsuccessful attempt at snaring MediPort catheter
2. Left upper extremity ultrasonography with interpretation.
ACCESS: Right common femoral with a 7 French sheath using ultrasound guidance.
CATHETERIZATIONS: 1. Left brachiocephalic vein 2. Right brachiocephalic vein.
FINDINGS: Catheter sits against the wall of the left brachiocephalic vein and could not be snared. I believe that it has been encapsulated by neointima.
PROCEDURE: The patient gave informed consent and was taken to the endovascular lab. She was given sedation and we prepped and draped her groins. We did a timeout. I used the ultrasound to visualize her common femoral vein and injected 1% Lidocaine as a field block The vein was cannulated percutaneously under real time ultrasound guidance. Sheath was secured over a wire and put a 45 cm 7 French sheath up through the heart over the wire to the superior vena cava. I then used a combination of catheters and wires and snares to grab this catheter. I used angled glidecatheter and a Glidewire and then three different snares including the smaller sizes and then the larger 1830 M snare. This was not successful. I then placed an RDC 6 French guiding catheter and used this to torque and change the angle to do different obliquities including lateral views and I could get the snare up against the catheter, but I could never actually grasp it. I could never get all the way around it. I then prepped and draped the left upper extremity and used the ultrasound and tried to get into the basilica vein thinking that I could snare it from a basilica approach. She does not have a basilica vein. She has patent brachial vein, but with an INR of 2.9, I did not feel good about sticking her brachial vein. I tried again from the groin and ultimately decided to stop.
Fluoro time was 20 minutes in total with 1164 milligray and 6645 DAP. The catheter is clearly not in jeopardy of embolization and I am going to recommend leaving it alone. She is taken back to the ICU for her fresh frozen plasma and for sheath removal.