codedog
True Blue
I am confused on how i should code this , any suggestions ? is the trialysis catheter tunneled, should i code the attempted procedure ?
thanks
POSTOPERATIVE DIAGNOSES: Acute on chronic renal failure.
PROCEDURE:
1. Attempted insertion of right and left internal jugular vein permanent dialysis
catheter using ultrasound and flouroscopic guidance.
2. Placement of Right Femoral Vein Trialysis HD catheter
IMPLANT: 16F 20cm triple lumen temporary dialysis catheter
S
PROCEDURE IN DETAIL: The patient was identified in the Preoperative Unit and
taken back to the Operating Room and laid supine on the operating room table.
IV antibiotics were administered prior to the administration of the anesthesia.
MAC anesthesia was administered without complication. The patient was then
prepped and draped in a standard sterile fashion. Timeout procedure was
performed in accordance with hospital protocol. An ultrasound was used to
identify the right and left internal jugular veins. The images were interpreted by me
and stored for further review. The right internal jugular vein was accessed using a
needle. The wire was unable to be advanced beyond the neck. Using ultrasound we identified the left internal jugular vein. It was able to be easily accessed using a needle and a guidewire was advanced without difficulty. The position of the guidewire was confirmed with fluoroscopy. An incision in the left upper chest was
made and the catheter was tunneled was from this incision towards the neck incision without any issue. Once the
PermCath cuff was in the appropriate position at the chest site. Under fluoroscopic guidance we attempted to dilate the tract over the guidewire. This was difficult due to her extreme obesity. Upon advancing the dilator, the guidewire would kink upwards and the track would not dilate. We aborted any further attempts at internal jugular PermCath placement. The incisions at the left neck and chest were closed using interrupted Monocryl suture.
The patient was placed in slight trendelenburg position. The right groin was prepped and draped in typical standard fashion. The ultrasound was used to identify the right femoral vein which was found to be widely patent. Lidocaine 1% was injected over the planned incision site and a small skin knick was made. An 18 gauge needle was introduced under constant negative pressure into the vein under ultrasound guidance. There was a return of dark red, non-pulsatile blood and the wire was easily passed and confirmed in the vein using ultrasound. The tract was then serially dilated and then the trialysis catheter was introduced. All ports were found to aspirate with ease then were flushed with injectable saline. A biopatch was placed and the catheter was secured to the skin with sutures. A sterile, occlusive dressing was then applied. At the end the procedure all counts were correct the patient was woken from anesthesia without difficulty. She has returned to the recovery room in a stable condition
thanks
POSTOPERATIVE DIAGNOSES: Acute on chronic renal failure.
PROCEDURE:
1. Attempted insertion of right and left internal jugular vein permanent dialysis
catheter using ultrasound and flouroscopic guidance.
2. Placement of Right Femoral Vein Trialysis HD catheter
IMPLANT: 16F 20cm triple lumen temporary dialysis catheter
S
PROCEDURE IN DETAIL: The patient was identified in the Preoperative Unit and
taken back to the Operating Room and laid supine on the operating room table.
IV antibiotics were administered prior to the administration of the anesthesia.
MAC anesthesia was administered without complication. The patient was then
prepped and draped in a standard sterile fashion. Timeout procedure was
performed in accordance with hospital protocol. An ultrasound was used to
identify the right and left internal jugular veins. The images were interpreted by me
and stored for further review. The right internal jugular vein was accessed using a
needle. The wire was unable to be advanced beyond the neck. Using ultrasound we identified the left internal jugular vein. It was able to be easily accessed using a needle and a guidewire was advanced without difficulty. The position of the guidewire was confirmed with fluoroscopy. An incision in the left upper chest was
made and the catheter was tunneled was from this incision towards the neck incision without any issue. Once the
PermCath cuff was in the appropriate position at the chest site. Under fluoroscopic guidance we attempted to dilate the tract over the guidewire. This was difficult due to her extreme obesity. Upon advancing the dilator, the guidewire would kink upwards and the track would not dilate. We aborted any further attempts at internal jugular PermCath placement. The incisions at the left neck and chest were closed using interrupted Monocryl suture.
The patient was placed in slight trendelenburg position. The right groin was prepped and draped in typical standard fashion. The ultrasound was used to identify the right femoral vein which was found to be widely patent. Lidocaine 1% was injected over the planned incision site and a small skin knick was made. An 18 gauge needle was introduced under constant negative pressure into the vein under ultrasound guidance. There was a return of dark red, non-pulsatile blood and the wire was easily passed and confirmed in the vein using ultrasound. The tract was then serially dilated and then the trialysis catheter was introduced. All ports were found to aspirate with ease then were flushed with injectable saline. A biopatch was placed and the catheter was secured to the skin with sutures. A sterile, occlusive dressing was then applied. At the end the procedure all counts were correct the patient was woken from anesthesia without difficulty. She has returned to the recovery room in a stable condition