heart123
Guest
doc coded coronaries only
isnt this a LHC ????
thanks
Following this, a standard thin wall radial access needle was
used in order to perform a right radial arteriotomy. With excellent blood flow
visually confirmed, a radial access wire was advanced into the lumen of theright radial artery.
Using modified Seldinger technique, this needle wa
subsequently exchanged for a 6-French Slender sheath. Following removal of the
dilator and wire, excellent blood flow was noted on manual aspiration with the
syringe.
With the sheath in place, the patient was given intra-arterial medications to
assist with luminal patency including 2.5 mg of verapamil, 5000 units of
heparin, and 150 mcg of nitroglycerin. These contents were flushed with sterile
saline in standard fashion.
Subsequent to this, a 0.035 J-tipped wire was used in order to advance a
6-French Tiger diagnostic catheter into the ascending aorta. Following removal
of the wire and connection to the manifold, excellent pressure tracing was
noted. As such, this catheter was used in order to cannulate the ostium of the
left main coronary artery. No subsequent pressure tracing deviation was noted
and as such, multiplanar cineangiographic analysis of the left coronary system
was undertaken and demonstrated no evidence of angiographically significant
disease. As such, an attempt was made to cannulate the ostium of the right
coronary artery with the same catheter, though was unsuccessful due to likely
aortic dilatation. Subsequent to this, the Tiger catheter was exchanged over a
wire for a 5-French 3-DRC catheter. Following removal of wire and connection to
the manifold, excellent pressure tracing was noted and as such, this catheter
was used in order to cannulate the ostium of the right coronary artery.
Subsequent to this, pressure tracing remained excellent and as such, multiplanar
cineangiographic analysis was undertaken and consistent with no significant
angiographic disease.
The 3-DRC catheter was exchanged over a wire for a 5-French multipurpose
catheter. Subsequent to this, 2000 additional units of heparin were
administered. Under fluoroscopic guidance, a stiff straight Glidewire was
subsequently used to cross the aortic valve into the left ventricle. The
multipurpose catheter was advanced over this into the left ventricle. The
Glidewire was then subsequently exchanged for a 0.035 long J-tipped wire, which
facilitated exchange of the multipurpose for a standard 6-French Langston
catheter. Following removal of the wire and connection to both manifolds,
simultaneous pressure tracing measurements and analysis were undertaken, which
were summarized above.
Following this, a hand injection was done in order to achieve left
ventriculography with results summarized above.
Under fluoroscopic guidance and following completion of the appropriate
diagnostic maneuvers, the Langston catheter was removed over a 0.035 J-tipped
wire, which then was subsequently removed as well. At the conclusion of the
procedure, the sheath was removed in standard fashion with a transradial band
inflated with 12 mL of air. At the end of the procedure, it was noted that
there was no evidence of uncontrolled bleeding, neurologic status change,
hemodynamic or electrical instability, or any other issues consistent with an
acute procedural complication. Decision was made to transfer the patient to the
recovery area for further monitoring and ultimately return back to the telemetry
floor.
isnt this a LHC ????
thanks
Following this, a standard thin wall radial access needle was
used in order to perform a right radial arteriotomy. With excellent blood flow
visually confirmed, a radial access wire was advanced into the lumen of theright radial artery.
Using modified Seldinger technique, this needle wa
subsequently exchanged for a 6-French Slender sheath. Following removal of the
dilator and wire, excellent blood flow was noted on manual aspiration with the
syringe.
With the sheath in place, the patient was given intra-arterial medications to
assist with luminal patency including 2.5 mg of verapamil, 5000 units of
heparin, and 150 mcg of nitroglycerin. These contents were flushed with sterile
saline in standard fashion.
Subsequent to this, a 0.035 J-tipped wire was used in order to advance a
6-French Tiger diagnostic catheter into the ascending aorta. Following removal
of the wire and connection to the manifold, excellent pressure tracing was
noted. As such, this catheter was used in order to cannulate the ostium of the
left main coronary artery. No subsequent pressure tracing deviation was noted
and as such, multiplanar cineangiographic analysis of the left coronary system
was undertaken and demonstrated no evidence of angiographically significant
disease. As such, an attempt was made to cannulate the ostium of the right
coronary artery with the same catheter, though was unsuccessful due to likely
aortic dilatation. Subsequent to this, the Tiger catheter was exchanged over a
wire for a 5-French 3-DRC catheter. Following removal of wire and connection to
the manifold, excellent pressure tracing was noted and as such, this catheter
was used in order to cannulate the ostium of the right coronary artery.
Subsequent to this, pressure tracing remained excellent and as such, multiplanar
cineangiographic analysis was undertaken and consistent with no significant
angiographic disease.
The 3-DRC catheter was exchanged over a wire for a 5-French multipurpose
catheter. Subsequent to this, 2000 additional units of heparin were
administered. Under fluoroscopic guidance, a stiff straight Glidewire was
subsequently used to cross the aortic valve into the left ventricle. The
multipurpose catheter was advanced over this into the left ventricle. The
Glidewire was then subsequently exchanged for a 0.035 long J-tipped wire, which
facilitated exchange of the multipurpose for a standard 6-French Langston
catheter. Following removal of the wire and connection to both manifolds,
simultaneous pressure tracing measurements and analysis were undertaken, which
were summarized above.
Following this, a hand injection was done in order to achieve left
ventriculography with results summarized above.
Under fluoroscopic guidance and following completion of the appropriate
diagnostic maneuvers, the Langston catheter was removed over a 0.035 J-tipped
wire, which then was subsequently removed as well. At the conclusion of the
procedure, the sheath was removed in standard fashion with a transradial band
inflated with 12 mL of air. At the end of the procedure, it was noted that
there was no evidence of uncontrolled bleeding, neurologic status change,
hemodynamic or electrical instability, or any other issues consistent with an
acute procedural complication. Decision was made to transfer the patient to the
recovery area for further monitoring and ultimately return back to the telemetry
floor.