Anderson Hospital 6800 State Route 162 Maryville, IL 62062 Operative Note SignedPatient: Towell,Alexander R MR#: M000499848 DOB: 08/04/1975 Acct:V00003688837Age: 48 ADM Date: 07/22/24 Loc: ANHSURGERY Attending Dr: Pei Chang Chung M.D.cc: Chung, Pei Chang MD; Suthan***, Nanthini MD~Procedure Note - DetailedDate of Procedure07/22/24Pre-op Diagnosis small-bowel adenocarcinomaPost-op DiagnosisSameProcedure Performed placement of left subclavian venous access device under fluoroscopic guidanceSurgeonPei Chang Chung, MDAnesthesiaMAC and LocalIndications 48-year-old male with small bowel adenocarcinoma status post right hemicolectomy now needing adjuvant chemotherapyFindings 1st stick left subclavianDescription of ProcedurePatient was brought into the operating room and placed in the supine position. After adequate induction of mac anesthesia, the patient was prepped and draped in normal sterile fashion. Time-out was then done to verify the patient's identity, as well as the procedure being performed. I began by making a small incision in the left chest, I then gained access into the left subclavian vein with an 18 gauge needle. I then placed the guidewire into the vein and confirmedplacement via fluoroscopic guidance. I then locally anesthetized the area in the left chest. I then enlarged the incision around the guidewire including making a subcutaneous pocket inferiorly to allow placement of the port itself. I then placed a dilating sheath over the guidewire into the left subclavian veinvia sterile Seldinger technique. This was once again done and confirmed via fluoroscopic guidance. I then removed the dilator and the guidewire, now just leaving the sheath in the vein. I then fed the previously flushed catheter intothe left subclavian vein under fluoroscopic guidance. At approximately 23 cm, the catheter was noted to be near the atrial caval junction. I then peeled awaythe sheath, now just leaving the catheter in the vein. I then was able to easily draw and flush from the catheter. The catheter was cut to fit and attached to the port itself. The port was placed into the previously made subcutaneous pocket and sutured in with 0 Ethibond suture. Final fluoroscopic view showed the termination of the catheter at the atrial caval junction with a nice smooth curvature back to the port itself. I was able to gain access to theport with a Huber needle and was able to easily draw and flush from the port. I then flushed 4 cc of a final heparin flush into the port. The incision was closed with 3 0 Vicryl suture in the subcutaneous tissue and the skin was closedwith 4 O Monocryl subcuticular suture. Dermabond was then placed on wound. Thepatient tolerated the procedure well and will be sent to the recovery room in stable condition.ImplantsL SCV VADEstimated Blood Loss5DrainsNoPackingNoPathologyNone sentComplicationsNo immediate complicationsConditionStableDispositionPACUAMG BillingSurgery - Charge Forward: Surgery BillingThis report may have been done utilizing a voice recognition system. Attempts have been made to correct errors. However, there may be uncorrected grammatical,spelling, and recognition errors present.Report Initialized date/time: Chung, Pei Chang MD 07/22/24 / 1557Electronically signed by: Chung, Pei Chang MD 07/22/24 1557

Home / Medical / Anderson Hospital 6800 State Route 162 Maryville, IL 62062 Operative Note SignedPatient: Towell,Alexander R MR#: M000499848 DOB: 08/04/1975 Acct:V00003688837Age: 48 ADM Date: 07/22/24 Loc: ANHSURGERY Attending Dr: Pei Chang Chung M.D.cc: Chung, Pei Chang MD; Suthan***, Nanthini MD~Procedure Note - DetailedDate of Procedure07/22/24Pre-op Diagnosis small-bowel adenocarcinomaPost-op DiagnosisSameProcedure Performed placement of left subclavian venous access device under fluoroscopic guidanceSurgeonPei Chang Chung, MDAnesthesiaMAC and LocalIndications 48-year-old male with small bowel adenocarcinoma status post right hemicolectomy now needing adjuvant chemotherapyFindings 1st stick left subclavianDescription of ProcedurePatient was brought into the operating room and placed in the supine position. After adequate induction of mac anesthesia, the patient was prepped and draped in normal sterile fashion. Time-out was then done to verify the patient's identity, as well as the procedure being performed. I began by making a small incision in the left chest, I then gained access into the left subclavian vein with an 18 gauge needle. I then placed the guidewire into the vein and confirmedplacement via fluoroscopic guidance. I then locally anesthetized the area in the left chest. I then enlarged the incision around the guidewire including making a subcutaneous pocket inferiorly to allow placement of the port itself. I then placed a dilating sheath over the guidewire into the left subclavian veinvia sterile Seldinger technique. This was once again done and confirmed via fluoroscopic guidance. I then removed the dilator and the guidewire, now just leaving the sheath in the vein. I then fed the previously flushed catheter intothe left subclavian vein under fluoroscopic guidance. At approximately 23 cm, the catheter was noted to be near the atrial caval junction. I then peeled awaythe sheath, now just leaving the catheter in the vein. I then was able to easily draw and flush from the catheter. The catheter was cut to fit and attached to the port itself. The port was placed into the previously made subcutaneous pocket and sutured in with 0 Ethibond suture. Final fluoroscopic view showed the termination of the catheter at the atrial caval junction with a nice smooth curvature back to the port itself. I was able to gain access to theport with a Huber needle and was able to easily draw and flush from the port. I then flushed 4 cc of a final heparin flush into the port. The incision was closed with 3 0 Vicryl suture in the subcutaneous tissue and the skin was closedwith 4 O Monocryl subcuticular suture. Dermabond was then placed on wound. Thepatient tolerated the procedure well and will be sent to the recovery room in stable condition.ImplantsL SCV VADEstimated Blood Loss5DrainsNoPackingNoPathologyNone sentComplicationsNo immediate complicationsConditionStableDispositionPACUAMG BillingSurgery - Charge Forward: Surgery BillingThis report may have been done utilizing a voice recognition system. Attempts have been made to correct errors. However, there may be uncorrected grammatical,spelling, and recognition errors present.Report Initialized date/time: Chung, Pei Chang MD 07/22/24 / 1557Electronically signed by: Chung, Pei Chang MD 07/22/24 1557