# cathater placement



## churst21 (Jun 14, 2012)

Fluoroscopically guided tunneled transhepatic venous central line placement; hepatic venography; left and right jugular 
ultrasound; right subclavian catheter injection:

Procedure: Chronically debilitated patient on long-term care. Request for central line access for dopamine and antibiotics.

Unsuccessful attempt by anesthesia at left and right jugular central line placement. A right upper chest wall vein was 
catheterized.. No central venous access

Procedure: Informed consent obtained the family. Initial ultrasound of both the left and right neck demonstrate no 
visualization of either the external or internal jugular veins which are seen to be chronically occluded. The right upper 
chest/subclavian catheter was injected and demonstrates tip is within a cast of collateral veins in the right paraspinal 
region. Findings indicate long-standing chronic Central venous obstruction. Patient is markedly contracted so access to 
the femoral veins is unobtainable there Therefore it was elected to perform transhepatic venous central line placement.

Using sterile technique, local anesthesia and fluoroscopic guidance as well as conscious sedation a 22-gauge Chiba 
needle was inserted into the middle hepatic vein. Guidewire is advanced in the right atrium. Fascial dilatation was 
performed and a 7-French peel-away sheath was advanced to level the right atrium.

A subcutaneous tunnel was created several centimeters from the entrance site. Through the tunnel a 33-cm/6-French 
POWER -- LINE central line was pulled and advanced through the peel-away sheath with the tip placed entering the right 
atrium and coursing up the lower SVC. All ports function well and the catheter sutured in place.

Impression: Jugular and femoral dialysis catheter access could not be achieved as discussed above. Successful 
transhepatic venous tunneled central line placement as discussed above.

would it be 36571 or 36561


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## dpeoples (Jun 14, 2012)

churst21 said:


> Fluoroscopically guided tunneled transhepatic venous central line placement; hepatic venography; left and right jugular
> ultrasound; right subclavian catheter injection:
> 
> Procedure: Chronically debilitated patient on long-term care. Request for central line access for dopamine and antibiotics.
> ...



This is more than a bit unusual, but it still fits the criteria for 36558,77001-26,76937-26

HTH


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