bevlewis07
Networker
Hello, I need help coding this because I have not had a case where selective infusion was used.
PROCEDURES:
Bilateral internal carotid artery Wada testing:
1. Introduction of needle and catheter into the right femoral artery.
2. Selective catheter placement, second order arterial, into left internal
carotid artery.
3. Angiography, left internal carotid artery, PA and lateral projection
centered over the intracranial circulation.
4. Selective infusion of 5 mg of methohexital via the left internal carotid
artery manually.
5. Selective catheter placement, first order arterial, into the left common
carotid artery.
6. Angiography, left common carotid artery, PA and lateral projection centered
over the intracranial circulation.
7. Selective catheter placement, third order arterial, into the right internal
carotid artery.
8. Angiography, right internal carotid artery, PA and lateral projection
centered over the intracranial circulation.
9. Selective infusion of 5 mg of methohexital via the right internal carotid
artery manually.
10. Selective catheter placement, second order arterial, into right common
carotid artery.
11. Angiography, right common carotid artery, PA and lateral projection
centered over the intracranial circulation.
INDICATIONS: This is a 44-year-old woman who has undergone multiple procedures
for refractory seizure disorder. I have been asked by the neurology department
to perform bilateral internal carotid artery Wada testing.
PROCEDURE IN DETAIL: The patient was taken to the angiography suite where the
right femoral region was prepped and draped. Access into the right common
femoral artery was achieved using a micropuncture kit. Under ultrasonographic
visualization, patency of the artery was seen and an image was downloaded. A
5-French introducer sheath was placed in the artery, taped in place and attached
to the standard heparinized flush solution. Next, a diagnostic catheter was
navigated into the left internal carotid artery. Angiography was performed in a
PA and lateral projection, demonstrating no evidence of intracranial vascular
abnormality. At this point, the neurology team performed their initial
assessment of the patient. Following this, 5 mg of methohexital was infused
slowly manually via the left internal carotid artery. Following this, the
neurology team again performed their neurological evaluation of the patient.
Following this, the catheter was pulled into the left common carotid artery.
Angiography was performed in a PA and lateral projection, demonstrating no
evidence of intracranial branch abnormality. At this point, the catheter was
then navigated into the right internal carotid artery. Angiography was
performed in a PA and lateral projection, demonstrating no evidence of vascular
abnormality. At this point, the neurology team came into the room and
reevaluated the patient neurologically. Following this, 5 mg of methohexital
was then slowly infused manually via the right radial artery. At this point,
the neurology team reevaluated the patient. The catheter was then pulled into
the right common carotid artery. Angiography was performed in a PA and lateral
projection, demonstrating no evidence of intracranial branch abnormality. At
this point, the catheters were withdrawn from the patient. Hemostasis of the
right femoral puncture site was achieved using the Mynx closure device. Of
note, I was present during the critical portions of the procedure including the
arterial catheterizations, the interpretation of the angiographic images and the
methohexital infusion into the bilateral internal carotid arteries. The patient
subsequently was taken in normal neurological condition to the PPU.
PROCEDURES:
Bilateral internal carotid artery Wada testing:
1. Introduction of needle and catheter into the right femoral artery.
2. Selective catheter placement, second order arterial, into left internal
carotid artery.
3. Angiography, left internal carotid artery, PA and lateral projection
centered over the intracranial circulation.
4. Selective infusion of 5 mg of methohexital via the left internal carotid
artery manually.
5. Selective catheter placement, first order arterial, into the left common
carotid artery.
6. Angiography, left common carotid artery, PA and lateral projection centered
over the intracranial circulation.
7. Selective catheter placement, third order arterial, into the right internal
carotid artery.
8. Angiography, right internal carotid artery, PA and lateral projection
centered over the intracranial circulation.
9. Selective infusion of 5 mg of methohexital via the right internal carotid
artery manually.
10. Selective catheter placement, second order arterial, into right common
carotid artery.
11. Angiography, right common carotid artery, PA and lateral projection
centered over the intracranial circulation.
INDICATIONS: This is a 44-year-old woman who has undergone multiple procedures
for refractory seizure disorder. I have been asked by the neurology department
to perform bilateral internal carotid artery Wada testing.
PROCEDURE IN DETAIL: The patient was taken to the angiography suite where the
right femoral region was prepped and draped. Access into the right common
femoral artery was achieved using a micropuncture kit. Under ultrasonographic
visualization, patency of the artery was seen and an image was downloaded. A
5-French introducer sheath was placed in the artery, taped in place and attached
to the standard heparinized flush solution. Next, a diagnostic catheter was
navigated into the left internal carotid artery. Angiography was performed in a
PA and lateral projection, demonstrating no evidence of intracranial vascular
abnormality. At this point, the neurology team performed their initial
assessment of the patient. Following this, 5 mg of methohexital was infused
slowly manually via the left internal carotid artery. Following this, the
neurology team again performed their neurological evaluation of the patient.
Following this, the catheter was pulled into the left common carotid artery.
Angiography was performed in a PA and lateral projection, demonstrating no
evidence of intracranial branch abnormality. At this point, the catheter was
then navigated into the right internal carotid artery. Angiography was
performed in a PA and lateral projection, demonstrating no evidence of vascular
abnormality. At this point, the neurology team came into the room and
reevaluated the patient neurologically. Following this, 5 mg of methohexital
was then slowly infused manually via the right radial artery. At this point,
the neurology team reevaluated the patient. The catheter was then pulled into
the right common carotid artery. Angiography was performed in a PA and lateral
projection, demonstrating no evidence of intracranial branch abnormality. At
this point, the catheters were withdrawn from the patient. Hemostasis of the
right femoral puncture site was achieved using the Mynx closure device. Of
note, I was present during the critical portions of the procedure including the
arterial catheterizations, the interpretation of the angiographic images and the
methohexital infusion into the bilateral internal carotid arteries. The patient
subsequently was taken in normal neurological condition to the PPU.