Procedures:
After informed consent was obtained, the patient was taken to the interventional suite, and sterilely prepped and draped in the usual fashion. Local anesthesia was provided with 1% Lidocaine with epi. The cuff was bluntly dissected free from the subcutaneous tissues and the enveloping fibrin sheath, and extracted. Guide wire access was obtained into the IVC. An angiogram of the SVC was then completed, demonstrating an obstructive fibrin sheath in the SVC. The sheath obstruction was greater than 60%. 10mm PTA was performed in the SVC to relieve the obstruction. A new 36cm Ash Split catheter was then placed over guide wire and positioned in the right atrium under direct fluoroscopic guidance. Both ports pull and flush easily. The catheter is fixed to the chest wall with 0-Neurolon suture.
Estimated Blood Loss: 5ml
Amount of Radiocontrast used: 10ml
Fluoro time: 1:33 minutes:seconds
Impressions: Successful removal and replacement of left IJ tunneled cuffed dialysis catheter. Fibrin sheath obstruction post PTA of the SVC.
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35476 vs 36595 - Fibrin sheath obstruction removal during IJ dialysis cath exchange