PROCEDURE:,  Permacath placement.,INDICATION: , Renal failure.,IMPRESSION: , Status post successful placement of a #4-French Permacath dialysis catheter.,DISCUSSION:,  After informed consent was obtained at the request of Dr. Xyz, Permacath placement was performed.,The right neck and anterior chest were sterilely cleansed and draped.  Lidocaine 1% buffered with sodium bicarbonate was used as a local anesthetic.  Using ultrasound guidance, a micropuncture needle was advanced into the internal jugular vein.  The wire was then advanced with fluoroscopic guidance.  A dilator was placed.  An incision was then made at the puncture site for approximately 1 cm in the neck.  A 1 cm incision was also made in the anterior chest.  The catheter was tunneled subcutaneously from the incision on the anterior chest, out the incision of the neck.  Following this, over the wire, the tract into the internal jugular vein was dilated and a peel-away sheath was placed.  The catheter was then advanced through the peel-away sheath.  The peel-away sheath was removed.  The catheter was examined under fluoroscopic imaging and was in satisfactory position.  Both ports were aspirated and flushed easily.  Following this, the incision on the neck was closed with 2 #3-0 silk sutures.  The incision on the anterior chest was also closed 2 #3-0 silk sutures.,The patient tolerated the procedure well.  No complications occurred during or immediately after the procedure.  The patient was returned to her room in satisfactory condition.surgery, permacath placement, permacath, renal failure, anterior chest, catheter, dialysis, fluoroscopic, fluoroscopic guidance, internal jugular vein, micropuncture, needle, sheath, sutures, ultrasound guidance, internal jugular, jugular vein, placement, 