Position: Supine
Time: 30-60 min (short)
Blood Loss: Very Low (5-10 ml)
Post-op Pain: Minimal (1-3)
Maintenance Paralytic: No
Lead: Yes

Multiple comorbidities – These patients can be very sick. There are times (eg. at local anesthetic injection) that you would normally give some added sedation. However, be very careful! Gaige the patient’s toleration to sedatives and judicially administer drugs. It is recommended to be much more conservative with these patients.

Fluid Status – Ask preoperatively when the last dialysis treatment was. This, along with cap refill, mucous membranes, intake, output, etc will help to determine if the patient is “wet” or “dry”. Again, leaning towards a conservative fluid replacement is recommended!

Approach – the surgeon will inject local anesthesia in the area where the catheter will be inserted. Depending on how sick the patient is, 0.5-2mg versed or 25-100mcg fentanyl is usually given. A propofol drip can be started if the patient is able to tolerate it. General anesthesia may need to be used if the procedure is anticipated to be complicated or if the patient has multiple comorbidities that would necessitate GA.

Early Airway Precautions – the insertion site is going to be on the chest or even higher (above the clavicle), so anticipate the drape and surgeon to be in your space! With this in mind, it’s recommended to have a simple O2 mask on the patient and an airway close by.

Fluoroscopy / Xray (general considerations): Have lead aprons and thyroid shields available. Alternatively, distancing yourself 3 to 6 feet will reduce scatter radiation to 0.1% to 0.025% respectively. Occupational maximum exposure to radiation should be limited to a maximum average of 20 Sv (joules per kilogram – otherwise known as the Sievert/Sv) per year over a 5 year period. Limits should never exceed 50 Sv in a single year.

The Tesio catheter, or the Tesio-Power-Trialysis (TPT) catheter, is a long-term central venous catheter used for hemodialysis. It provides vascular access for patients requiring prolonged hemodialysis treatments.

The surgeon will begin by identifying which vein they want to place the catheter in. Typically the internal jugular vein or the subclavian vein are used. A small incision is then made and a tunnel is created under the skin from the incision site to an exit site. The catheter is threaded under the skin to minimize the risk of infection.

Fluoroscopy is often used to help visualize the placement of the catheter.