# Port-A-Cath Insertion Jugular



## BABS37 (Jun 5, 2012)

Can someone check this for me and see if this is right? I'm not sure if this is the right spot to post it either. 

1. Right Internal Jugular Port-A-Cath Insertion
2. Central Venography
3. Image guided access of central vein

I chose 36561, 75860, and 76937 ??

The patient was brought in and placed in the supine postition. The right chest was prepped and draped sterily. 1% lidocaine was infiltrated and the subclavian vein was accessed with a single puncture. The guidewire was passed under fluroscopy and preferentially seemed to travel at the internal jugular vein. The guidewire was switched out to a 35 Glidewire, this unfortunately also repeatedly traveled up the internal jugular. Floppy tip Bentson cerebral wire was then inserted, this as well was unable t be maneuvered in an inferior direction down into the superior vena cava. Catheter was inserted over the wire and the wire was withdrawn to maintain access through which hand injection of Optiray contrast was performed to obtain a central venogram. Central venogram demonstrated tortuous insertion of the internal jugular vein quite laterally on the subclavian vein which what was accessed rather then the subclavian vein and so there was no way that the wire would travel downwards. This site was abandoned and using ultrasound guidance, the right internal jugular vein was punctured. A guidewire was passed under fluoroscopy down into the superior vena cava and down onto the inferior vena cava. Counter incision was made on the right chest and silastic catheter was tunneled via counter incision up to the wire insertion site which was widened with an 11 blade and then dilator and sheath were inserted over the wire. The wire and dilator were removed. The catheter was inserted through the peel away sheath and the tip was positioned at the SVC atrial junction. The catheter was aspirated and flushed and tehn trimmed and attached to the port with the supplied hardware. The port was inserted in the pocket on teh right chest and packed with saline. Fluoroscopy showed no kinking of the catheter. Skin was then closed. 

Any thoughts on this one?


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## BABS37 (Jun 26, 2012)

It's me again  I have another similar OP Note and still have yet to learn how venography is coded... Is there anyone who can help with the vascular families? The more I read this, the more I think my codes are wrong and I am really confused...


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## syllingk (Jun 26, 2012)

Well for the main procedure it would be 36561, 77001-26. And it looks like the venogram would be 75860.


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