Choice of Catheter and Reservoir is the IV Device
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Transcript of Choice of Catheter and Reservoir is the IV Device
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Laparoscopic Placement of the BardPort Intraperitoneal Catheter and Reservoir
Dr. Arlan F. Fuller, Jr.Gillette Center for Women's OncologyMassachusetts General Hospital
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Choice of Catheter and Reservoir is the IV Device
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Titanium Port with 9.6F attached catheter
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Pre-placement ProcedurePerform laparoscopy in the usual manner with umbilical placement of laparoscope trocar and survey of the abdominal cavity for adhesionsPlace a 5 mm operative trocar in a position contralateral to the side of proposed catheter placementIdentify the prospective site in the lower quadrant for entry of the catheter into the peritoneal cavity
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Mark the site for reservoir placement above the right costal margin
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Incise the skin and develop a pocket for the reservoir
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Incise the skin and develop a pocket for the reservoir
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Check that the reservoir fits snugly into the pocket
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Place the tunneler on the end of the catheter and start the passage deep to Scarpas fascia
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Place a 5 mm transverse incision at the target site
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Bluntly with a hemostat extend the incision beneath Scarpas fascia to contact the tunneler
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Pass the tunneler out through the target incision
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Pass the tunneler out through the target incision
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Pass the catheter through the tunnel and the target incision and cut catheter to remove tunneler
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Suture the reservoir in place to fascia and confirm catheter function
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Place introducer needle through target incision adjacent to catheter
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Visualize needle tip at the target site in the peritoneal cavity
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Pass the guidewire with J tip through the introducer needle
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Pass the guidewire with J tip through the introducer needle
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Visualize J tip of the wire at the target site in the peritoneal cavity
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Withdraw the introducer needle leaving the guidewire in place
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Insert the introducer with the 10F dilator over the guidewire into the peritoneal cavity
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Visualize the dilator AND the peel-away introducer in the peritoneal cavityDilatorDilatorIntroducer
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Withdraw both the wire and the dilator from the introducer
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Pass the catheter through the introducer and assist laparoscopically in advancing the catheter into the peritoneal cavity
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Peel away the introducer while holding the catheter in the peritoneal cavity
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Advance all the remaining catheter into the peritoneal cavity
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Adjust position of catheter tip and confirm function by injectionLast, subcuticular closure of all incisions