bhargavi
Guru
Conclusion
PROCEDURES
1. Right heart catheterization
2. Catheter directed thrombolysis of pulmonary artery
PROCEDURE NOTE
Informed consent was obtained after explaining risks and benefits to the patient. Both groins were draped and prepped in a sterile fashion. Patient was premedicated with 0.5 mg Versed and 50 mcg fentanyl IV altogether. After injecting 2% lidocaine, bilateral common femoral arteries were accessed using micropuncture and 8 French femoral sheath were inserted in both femoral veins. 6 French Swan-Ganz catheter was advanced to right side of the heart and pulmonary artery systolic pressure was measured. Patient was proceeded with catheter related thrombosis. EKOS catheters were advanced from both femoral veins into left and right pulmonary artery. It was difficult to find an advance catheter in the right pulmonary artery due to tortuosity. After using multiple different catheters and wires subsequently EKOS catheters were selectively advanced into right and left pulmonary arteries. Alteplase 2 mg bolus was given in each pulmonary arteries and subsequently both catheters were attached to alteplase infusion for thrombolysis as per protocol. Patient remained hemodynamically stable and tolerated procedure well overall.
IMPRESSION
Successful EKOS catheter thrombolysis catheter placement and bilateral pulmonary arteries wire femoral venous access.
RECOMMENDATIONS
Continue alteplase infusion for total 6 hours.
Continue argatroban infusion for anticoagulation.
i am thinking 37211-50
thanks in advance
PROCEDURES
1. Right heart catheterization
2. Catheter directed thrombolysis of pulmonary artery
PROCEDURE NOTE
Informed consent was obtained after explaining risks and benefits to the patient. Both groins were draped and prepped in a sterile fashion. Patient was premedicated with 0.5 mg Versed and 50 mcg fentanyl IV altogether. After injecting 2% lidocaine, bilateral common femoral arteries were accessed using micropuncture and 8 French femoral sheath were inserted in both femoral veins. 6 French Swan-Ganz catheter was advanced to right side of the heart and pulmonary artery systolic pressure was measured. Patient was proceeded with catheter related thrombosis. EKOS catheters were advanced from both femoral veins into left and right pulmonary artery. It was difficult to find an advance catheter in the right pulmonary artery due to tortuosity. After using multiple different catheters and wires subsequently EKOS catheters were selectively advanced into right and left pulmonary arteries. Alteplase 2 mg bolus was given in each pulmonary arteries and subsequently both catheters were attached to alteplase infusion for thrombolysis as per protocol. Patient remained hemodynamically stable and tolerated procedure well overall.
IMPRESSION
Successful EKOS catheter thrombolysis catheter placement and bilateral pulmonary arteries wire femoral venous access.
RECOMMENDATIONS
Continue alteplase infusion for total 6 hours.
Continue argatroban infusion for anticoagulation.
i am thinking 37211-50
thanks in advance