Category Archives: Arteriovenous fistula

January 21, 2015

Written by Nichollette Minix (class of 2014-2015)

OR7 Tracheostomy/Percutaneous Endoscopic Gastrostomy (PEG)

This double procedure was performed by Dr. Liu and Dr. Menen on January 13. The tracheostomy was the first procedure, which was creating a surgical airway in the trachea.  The PEG was the second half which, the doctors created an opening in the stomach to insert a feeding tube.


The patient is a young male, appeared to be in his early twenties.  He was born with a neurological disorder, making swallowing and breathing very difficult. He also has a severe lung infection.  As a result, the patient lacks the ability to receive adequate amounts of nutrition and oxygen to maintain his weight, which was clearly visible when he was transferred onto the operating table.  His body looked thin and fragile.


After the patient was placed on the operating table, the anesthesiologist began intravenous sedating the patient.  A shoulder roll was used to lift the shoulder, extended the neck and prepped the patient’s neck to make the area sterile.  Dr. Menen runs two fingers up and down his neck feeling his Adam’s apple and palpating the thyroid cartilage and cricothyroid cartilage.  Then, Dr. Mene made a vertical incision to the suprasternal notch.  She flips the scalpel over and uses the handle to open the incision.  Blood began to slowly profuse from the opening.  Dr. Menen inserted her index finger in the opening to palpate the thyroid. A second incision was made, which allowed the doctors to identify the cartilage rings.  Some form of solution was injected into the trachea; the syringe was removed while the needle portion remained in the trachea.  A wire was inserted into the needle along with a dilator.  At this point, the sedation was wearing off and the patient rose up from the table twice.  More sedation was delivered to the patient by the anesthesiologist, the staff waited for a couple of minutes before proceeding on.  Finally, the tracheostomy tube is inserted.

Dr. Menen and the medical student used an endoscope through the mouth to examine the upper region of the esophagus ensuring the location for the correct tube.  A small incision was made into the abdomen and the PEG tube was placed through the incision into the stomach.  This procedure took about 20 minutes.

OR2 Avfistula Revision

The patient has renal disease and is on dialysis.  An Arteriovenous fistula (AV fistula) Revision was performed by Dr. Harken and Dr. Lee. This procedure consists of connecting an artery to the vein of the left forearm so the blood can flow directly  into the vein.  The patient was prepped and sedated. Dr. Harken requested that the operating table be placeed in a diagonal position.  A Doppler ultrasound was passed over his arm to evaluate the blood flow.  A small incision was made to join together the cephalic vein and the radial artery.  The Doppler ultrasound made a loud high pitch sound, which was an indication to Dr. Harken, blood was not flowing accurately.  After making some adjustment to the radiocephalic fistula, the blood flowed smoothly based on the low tone sound, which is an indication that blood is flowing accurately. This procedure took the doctors only twenty-two minutes to do.