# Hepatic venography w/pres.msrmts & transjugular bx.



## margaret fahy (Feb 14, 2014)

02/14/14
Hey Guys,
For the following procedure, dr. does pressure measurements from right hepatic vein and right atrium.  I know I have an Hepatic venogram...36011 and 75889-59 and then 37200 and 75970 and 76937 for vascular access to jugular vein?
Can I get a witness!! 
Thanks...Margie

CLINICAL HISTORY: 13-year-old female patient status post bone
marrow transplantation and GVHD. Here for transjugular liver
biopsy with pressure measurements.  

PROCEDURE:
I- TRANSJUGULAR LIVER BIOPSY:
1. Venous access via the right internal jugular vein.
2. Catheterization of the right hepatic vein and venogram.
3. Pressure measurements including wedge pressure, right hepatic
vein, and right atrium.
4. Liver biopsy via the right hepatic vein.
5. Post biopsy venogram.
PROCEDURE IN DETAILS:
Limited ultrasound examination of the liver was performed. The
right hepatic vein was chosen for biopsy. Limited ultrasound
examination of the neck was performed demonstrating patent right
jugular vein. The access site of the internal jugular vein was
identified and overlying skin was marked. The skin neck and right
upper quadrant was prepped and prepped in usual sterile manner.
Under ultrasound guidance a 21 gauge needle was inserted into the
right internal jugular vein. Once venous blood return was
obtained a 0.018" Nitrex wire was inserted into the vein and
advanced to the right atrium. The small dermatotomy was made, the
tract was dilated, and a 10 French vascular sheath was
inserted into the right atrium.
A JB-1 catheter was advanced into the right hepatic vein and
venography was performed confirming the placement of the catheter
within the right hepatic vein. The location of the catheter was
confirmed with ultrasound of the liver. The catheter was
exchanged into 5 French Fogarty balloon catheter. The balloon was
inflated in the right hepatic vein and Wedge Hepatic venous
pressure( WHOP) was obtained. Then free hepatic venous pressure
was obtained within
the right hepatic vein and right atrium.
A 0.035 inch Amplatz wire was placed distally in the vein and the
introducer sheath for the biopsy needle was placed in the right
hepatic vein. 3 biopsies were performed in the anterior
orientation with fluoroscopic guidance.
A post biopsy venogram demonstrated a patent intact right hepatic
vein with no evidence of extravasation.
FINDINGS:
1. Pressure measurements:
Right atrial pressure 20 mmHg - on vent, 14mHg - off vent.
Wedge Balloon Hepatic venous pressure( WHOP)= 24 mmHg - on vent,
18mmHg - off vent
Free hepatic venous pressure (FHP)= 21 mmHg - on vent, 19mmHg -
off vent.
2. Three Biopsies were performed via the right hepatic vein in
the anterior orientation with no complications demonstrated on
the post venogram angiographic run.
Permanent ultrasound and fluoroscopic images were obtained and
stored in the PACS system.
IMPRESSION
1. Hepatic venous pressure gradient (HVPG) is less than 5 mmHg
which is within normal limits.
2. Successful uncomplicated transjugular liver biopsy via right
hepatic vein.


----------



## dpeoples (Feb 14, 2014)

margaret fahy said:


> 02/14/14
> Hey Guys,
> For the following procedure, dr. does pressure measurements from right hepatic vein and right atrium.  I know I have an Hepatic venogram...36011 and 75889-59 and then 37200 and 75970 and 76937 for vascular access to jugular vein?
> Can I get a witness!!
> ...



Your code choices look correct to me.

HTH


----------



## margaret fahy (Feb 14, 2014)

OMG....I'm so excited...thanks so much, Danny.  I got it right!
Hey....can you comment on my other question re CSF Flow study during MRI Brain or Spine?
I sent an example....documentation is scant....need to know what has to be documented for a CSF Flow study.
Thanks so much, Danny, and have a peaceful day.
Margie


----------

