09/14/2026
EXAMINATION: IR PORT PLACEMENT CHEST
HISTORY: Alpha-gal syndrome with the ongoing IVIG infusion scheduled as an outpatient has no access vasular attempted to replace midline/picc but not successful.
CONTRAST: none
COMPLICATIONS: none
MEDICATIONS:
Conscious sedation was administered under the physician's direction, and continuous monitoring was performed by an independent trained nurse specialist. Total monitored sedation time was 30 minutes. During the course of the procedure, the patient received 100 mcg of intravenous fentanyl.
PROCEDURE DESCRIPTION:
The patient was placed in a supine position. A Time-out procedure was performed. The patient was attached to continuous physiologic monitoring throughout the procedure. A limited ultrasound examination demonstrates a widely patent Internal Jugular vein.
The neck and chest were prepped and draped utilizing full-barrier sterile technique. All personnel wore masks and caps. The operators hands were washed. Sterile gowns and sterile gloves were worn. The patient's skin was prepped with alcohol and then draped with a standard sterile fenestrated sheet. The skin site was then reprepped with alcohol.
The skin and subcutaneous tissues at the base of the neck were anesthetized with 0.5%. A micropuncture needle was advanced into the internal jugular vein under real-time ultrasound guidance. A micro-puncture wire was advanced into the right atrium. A micropuncture sheath was advanced over the wire. The wire was exchanged for an 0.35 guidewire. This guidewire was advanced into the inferior vena cava under fluoroscopic guidance.
The skin and subcutaneous tissues of the chest were anesthetized with 0.5% Marcaine. A 3 cm incision was made. The port pocket was formed with blunt dissection. The catheter was tunneled to the venotomy site with blunt dissection. The catheter was advanced through a peel-away sheath and positioned under fluoroscopic guidance. The catheter was cut to length and attached to the hub of the port. The port flushes and aspirates easily. The port was secured within the port pocket with 3.0 Vicryl sutures. The port was flushed with sterile saline and a spot film radiograph was obtained demonstrating good position of the catheter tip. The port pocket was irrigated with sterile saline solution. The subcutaneous tissues are approximated with interrupted 3.0 Vicryl suture. The skin was approximated with Dermabond glue. At the venotomy site the skin was approximated with Dermabond glue. A sterile dressing was applied.
FINDINGS:
A limited Ultrasound examination demonstrates a patent Internal Jugular Vein. Real-time ultrasound was used to access the internal jugular vein via a lateral approach inferior to the sternocleidomastoid muscle.
Fluoroscopy was used to guide the catheter tip to the high right atrium. A spot film radiograph documents good position of the catheter tip.
IMPRESSION:
Successful ultrasound and fluoroscopic placement of a power-injectable right chest port. The port is ready for immediate use. Ultrasound and fluoroscopic images were saved in the medical record.
