philnamba
Contributor
My GS is having a hard time picking any codes I show him. What do yall think? Any input would be greatly appreciated.
Technique:
The patient was brought to the operating room and placed on the operating table in the supine position and monitored anesthesia care was administered. The abdomen and inferior chest were prepped with Chloraprep and draped with sterile towels and paper drapes. A time out was performed and prophylactic antibiotics were administered.
Once an adequate level of sedation was attained, the skin and subQ surrounding the pathology inferior to the right costal margin in the epigastrium was anesthetized with Marcaine 0.25%, using 15 ml. A longitudinal elliptical incision was made incorporating the pathology and continued through the hypodermis with electrocautery until the fascia was encountered. The specimen was dissected off of the fascia until a foreign body was palpated and this was dissected. It was a small, thin, orange wire that was consistent with external pacing lead wire that is used in cardiac surgery.
The granuloma dissection was completed and the specimen was freed from the surrounding tissues, anchored only by the wire. The superficial portion of the wire was well-incorporated into the granuloma, and as the wire was retracted it pulse with the cardiac rhythm, indicating it was still anchored in the pericardium. I broke scrubbed and called Dr. Robert Garrett, who had performed her heart surgery in 2011 to discuss the situation before proceeding. He assured me that this lead should be able to be pulled without difficulty or fear of complication. I scrubbed back in and with fairly gentle retraction this wire loosened and was removed entirely, with the deep, implanted portion intact.
The wound was irrigated and hemostasis obtained with electrocautery. The hypodermis was then closed with 2-0 Vicryl and the deep dermis reapproximated with 3-0 Vicryl. This approximated the skin edges well and Dermabond was applied to the incision.
The patient was awakened in the operating room having tolerated the procedure well. All needle, sponge, and instrument counts were correct times two at the end of the case. The patient was taken to post-anesthesia recover in stable condition, having tolerated the procedure well.
Technique:
The patient was brought to the operating room and placed on the operating table in the supine position and monitored anesthesia care was administered. The abdomen and inferior chest were prepped with Chloraprep and draped with sterile towels and paper drapes. A time out was performed and prophylactic antibiotics were administered.
Once an adequate level of sedation was attained, the skin and subQ surrounding the pathology inferior to the right costal margin in the epigastrium was anesthetized with Marcaine 0.25%, using 15 ml. A longitudinal elliptical incision was made incorporating the pathology and continued through the hypodermis with electrocautery until the fascia was encountered. The specimen was dissected off of the fascia until a foreign body was palpated and this was dissected. It was a small, thin, orange wire that was consistent with external pacing lead wire that is used in cardiac surgery.
The granuloma dissection was completed and the specimen was freed from the surrounding tissues, anchored only by the wire. The superficial portion of the wire was well-incorporated into the granuloma, and as the wire was retracted it pulse with the cardiac rhythm, indicating it was still anchored in the pericardium. I broke scrubbed and called Dr. Robert Garrett, who had performed her heart surgery in 2011 to discuss the situation before proceeding. He assured me that this lead should be able to be pulled without difficulty or fear of complication. I scrubbed back in and with fairly gentle retraction this wire loosened and was removed entirely, with the deep, implanted portion intact.
The wound was irrigated and hemostasis obtained with electrocautery. The hypodermis was then closed with 2-0 Vicryl and the deep dermis reapproximated with 3-0 Vicryl. This approximated the skin edges well and Dermabond was applied to the incision.
The patient was awakened in the operating room having tolerated the procedure well. All needle, sponge, and instrument counts were correct times two at the end of the case. The patient was taken to post-anesthesia recover in stable condition, having tolerated the procedure well.