Anesthesia and Positioning
Supine, arms tucked, shoulder roll
Prep chin to nipples
Slight T-berg
Port Supplies and Set-up
Ultrasound
SmartPort Plastic 8F
Protected bovie tip
Sensorcaine .5% – 30ml
Connect catheter to the tunneler on the small numbers side
Heparin flush – syringe with yellow top – 4 in room, 2 open
Prolene 2.0 ct-2 or sh
Vicryl 3-0
Monocryl 4-0
Dermabond
Gloves: 8 1/2 blue and 8 pink micro
Steps for Placement
Be awesome
Ultrasound neck before prep
Prep and drape
Use local needle to find vessel under U/S guidance(trampoline), then numb skin
15-blade to make small skin incision
U/S guided large bore needle and then wire placement, see wire with U/S after placement
Mark pocket – draw with marker path of catheter, finger breadth below clavicle
Inject local in pocket and tunnel
Incision, cautery dissect down to fascia
Army/Navy to expose facia and use cautery to create pocket
2-0 prolene anchor sutures
Tunnel catheter
Under fluoro place dilator/sheath
Pass catheter in to 25cm, peel away the sheath
Measure depth under fluoro
Pull back 2cm and then cut catheter and attach port
Flush with 3cc
Place prolene sutures through port
Use army navy to insert into pocket
Tie prolene sutures, confirm with fluoro
Flush one more time
Close fascia with 3-0 vicryl running
Close neck incision and then pocket incision subcuticular with monocryl
Place dermabond