lcouto
Networker
If anyone could help please... I was thinking that this would be a 33216 but not sure..
Pre-procedure Diagnoses
1. Atrial pacemaker lead displacement
Post-procedure Diagnoses
1. Atrial pacemaker lead displacement
Procedures
1. LEAD REVISION
BRIEF OPERATIVE NOTE
Pre-operative Diagnosis:
Atrial pacemaker lead displacement
Post-operative Diagnosis:
Same as above
Implants and Procedure Description:
After informed consent was obtained, the patient was transported in a nonsedated condition to the cardiac catheterization suite. The patient was given moderate conscious sedation. The patient was prepped and draped in a sterile fashion and a "timeout" was taken.
Lidocaine was used to infiltrate the skin and subcutaneous tissue overlying the left pectoralis muscle. Sharp incision was made in the skin. Utilizing a combination of sharp and blunt dissection, the old pulse generator was dissected from its pocket in the prepectoral fascia. The generator was removed and the atrial lead was tested and found to have non-capture. The ventricular lead remained connected to the pulse generator. The atrial lead was capped and secured to the pectoralis muscle with non-resorbable suture.
Under fluoroscopic guidance, percutaneous access was then obtained the left subclavian vein. Over an .035 wire a dilator and sheath were placed. The wire and dilator were exchanged then for the new atrial pacing lead. The lead was an active fixation lead Utilizing curved and straight stylettes, the lead was positioned and secured in the right atrial appendage. It was tested and found to have P waves of 2.8 mV, impedance 745 ohms, threshold was 1.2 volts, current 2.1 milliamps. Adequate slack was placed in the lead under fluoroscopic guidance. The lead was tested with an output of 10 V and did not stimulate the diaphragm.
CLOSURE:
The leads were then secured to the pectoralis muscle with non-resorbable suture. I then attached the pulse generator The leads and pulse generator were incorporated in the pocket. The pocket was copiously irrigated. The subcutaneous fascia was closed with interrupted Vicryl suture. The skin layer was closed with a subcuticular Vicryl stitch. Final fluoroscopy demonstrated adequate slack in the leads. The wound was dressed in a sterile fashion.
Pre-procedure Diagnoses
1. Atrial pacemaker lead displacement
Post-procedure Diagnoses
1. Atrial pacemaker lead displacement
Procedures
1. LEAD REVISION
BRIEF OPERATIVE NOTE
Pre-operative Diagnosis:
Atrial pacemaker lead displacement
Post-operative Diagnosis:
Same as above
Implants and Procedure Description:
After informed consent was obtained, the patient was transported in a nonsedated condition to the cardiac catheterization suite. The patient was given moderate conscious sedation. The patient was prepped and draped in a sterile fashion and a "timeout" was taken.
Lidocaine was used to infiltrate the skin and subcutaneous tissue overlying the left pectoralis muscle. Sharp incision was made in the skin. Utilizing a combination of sharp and blunt dissection, the old pulse generator was dissected from its pocket in the prepectoral fascia. The generator was removed and the atrial lead was tested and found to have non-capture. The ventricular lead remained connected to the pulse generator. The atrial lead was capped and secured to the pectoralis muscle with non-resorbable suture.
Under fluoroscopic guidance, percutaneous access was then obtained the left subclavian vein. Over an .035 wire a dilator and sheath were placed. The wire and dilator were exchanged then for the new atrial pacing lead. The lead was an active fixation lead Utilizing curved and straight stylettes, the lead was positioned and secured in the right atrial appendage. It was tested and found to have P waves of 2.8 mV, impedance 745 ohms, threshold was 1.2 volts, current 2.1 milliamps. Adequate slack was placed in the lead under fluoroscopic guidance. The lead was tested with an output of 10 V and did not stimulate the diaphragm.
CLOSURE:
The leads were then secured to the pectoralis muscle with non-resorbable suture. I then attached the pulse generator The leads and pulse generator were incorporated in the pocket. The pocket was copiously irrigated. The subcutaneous fascia was closed with interrupted Vicryl suture. The skin layer was closed with a subcuticular Vicryl stitch. Final fluoroscopy demonstrated adequate slack in the leads. The wound was dressed in a sterile fashion.
