afryberger
Networker
This is probably something really simple but my one Dr. sent us this op report and i cant quite wrap my head around what is going on. He is doing an axillary conduit creation with a hemashield gold knitted graft and insertion of intra aortic balloon pump. I under stand the balloon pump is 33967. But for the other part not sure. I looked up what Hemashield gold was and it brought me to aneurysm repair. He doesn't talk about an aneurysm any where.
http://www.atriummed.com/en/vascular/Documents/HemashieldPlatinumMCV00003886 RevA.pdf
I thought it was for the Axially ECMO placement(33954) but the more i keep reading the op report, the more confused i get. I'm lost, if someone could help me that would be awesome.
PROCEDURE:
Patient was brought into the CT OR and transferred from the bed onto the table. Patient was hemodynamically stable yet on small doses of pressors and a large dose of inotropes. We then proceeded with exposure of right axillary artery. Hemostasis was achieved by Bovie electrocautery. Some of the venous branches and arterial branches had to be tied off with 2-0 silk sutures. Once the vein was visualized, it was pushed down, that allowed exposure of the axillary artery, which was extremely small measuring about 6 mm in diameter. The artery was exposed. Patient was given 3000 of heparin and proximal and distal control of the artery was obtained. Small arteriotomy was performed and end-to-side anastomosis was carried out between the 8 mm graft and axillary artery. Hemostasis was ensured with additional sutures of 7-0 Prolene and Vicryl was used to ensure the hemostasis of the graft. Graft was de-aired and tunneled under the skin in a way to avoid this kinking of the graft. We then proceeded with the insertion of the balloon pump sheath through a separate stick in the graft. The wire was passed
all the way into the descending aorta under guidance of transesophageal echo. The Glide catheter was inserted over the Glidewire into the ascending aorta and exchanged onto the balloon pump wire. We then proceeded with insertion of balloon pump over the balloon pump wire until the distal aspect of the balloon was visualized on transesophageal echo, being distal to left subclavian artery. Once position of the balloon was confirmed with 1:3 augmentation, we then proceeded with closure of the conduit distally with a number of 0 silk ties followed by a number of ties over the conduit and the balloon pump catheter. The distal end of the conduit was stapled off with a vascular stapler. The balloon was secured to patient's skin. Patient was mentating appropriately and tolerated the procedure well. The tissues over the conduit were close with 0 Vicryl suture followed by closure of skin with 4-0 Monocryl. Once procedure was completed, we then transferred the patient onto the bed and escorted the patient to CTICU in critical but stable condition.
http://www.atriummed.com/en/vascular/Documents/HemashieldPlatinumMCV00003886 RevA.pdf
I thought it was for the Axially ECMO placement(33954) but the more i keep reading the op report, the more confused i get. I'm lost, if someone could help me that would be awesome.
PROCEDURE:
Patient was brought into the CT OR and transferred from the bed onto the table. Patient was hemodynamically stable yet on small doses of pressors and a large dose of inotropes. We then proceeded with exposure of right axillary artery. Hemostasis was achieved by Bovie electrocautery. Some of the venous branches and arterial branches had to be tied off with 2-0 silk sutures. Once the vein was visualized, it was pushed down, that allowed exposure of the axillary artery, which was extremely small measuring about 6 mm in diameter. The artery was exposed. Patient was given 3000 of heparin and proximal and distal control of the artery was obtained. Small arteriotomy was performed and end-to-side anastomosis was carried out between the 8 mm graft and axillary artery. Hemostasis was ensured with additional sutures of 7-0 Prolene and Vicryl was used to ensure the hemostasis of the graft. Graft was de-aired and tunneled under the skin in a way to avoid this kinking of the graft. We then proceeded with the insertion of the balloon pump sheath through a separate stick in the graft. The wire was passed
all the way into the descending aorta under guidance of transesophageal echo. The Glide catheter was inserted over the Glidewire into the ascending aorta and exchanged onto the balloon pump wire. We then proceeded with insertion of balloon pump over the balloon pump wire until the distal aspect of the balloon was visualized on transesophageal echo, being distal to left subclavian artery. Once position of the balloon was confirmed with 1:3 augmentation, we then proceeded with closure of the conduit distally with a number of 0 silk ties followed by a number of ties over the conduit and the balloon pump catheter. The distal end of the conduit was stapled off with a vascular stapler. The balloon was secured to patient's skin. Patient was mentating appropriately and tolerated the procedure well. The tissues over the conduit were close with 0 Vicryl suture followed by closure of skin with 4-0 Monocryl. Once procedure was completed, we then transferred the patient onto the bed and escorted the patient to CTICU in critical but stable condition.
