AshleyMartin
Networker
I am unsure how to code this procedure. A BiV ICD implant was started but only the right ventricular lead was placed and then the patient coded. The lead was then removed. Here is the report:
Using a modified Seldinger technique a 0.035 J-wire was advanced into the left subclavian vein. We advanced 2 other 0.035 J-wires in anticipation of doing the Bi-V AICD. The pocket was then created in the usual fashion and we advanced the right ventricular lead over a peel-away sheath. This was advanced into the right ventricle. As soon as the right ventricular lead got into the right ventricle, we started seeing some PVCs and then the patient went into V-tach. We cardioverted him but the patient had refractory V-tach which degenerated into ventricular fibrillation. A code was initiated. The patient was intubated. CPR started and advanced ACLS protocol was done. Despite aggressive treatment the patient remained in ventricular fibrillation. IV epi, lidocaine, amiodarone, procainamide, magnesium, bicarb were given with no significant results. CPR was continued throughout the code and I refer you to the code note for full details. Approximately 35 minutes into the code it appeared that the patient had severe refracroty arrhythmias not responding to all modalities of treatment. It was decided to give IV Lopressor and with this the patient was able to be cardioverted into a sinus rhythm with a blood pressure initially of 70. He was placed on dopamine and the blood pressure quickly rose to over 100. The patient remained intubated. Prior to shocking him we did try to overdrive pace him with the AICD lead but this was unsuccessful as well. In view of this, we aborted the procedure. We removed all the leads and the wires, and the pocket after being cleansed with antibiotic solution was closed in the usual fashion. The patient remained unresponsive and was transferred to the ICU. The family was notified. The patient within hours started waking up and made a full recovery to his preadmission state. I will not recommend to attempt to place another AICD because of the high risk and the refractory nature of the ventricular tachycardia.
Any help would be greatly appreciated! I am just unsure of how to code this!
Thanks!
Using a modified Seldinger technique a 0.035 J-wire was advanced into the left subclavian vein. We advanced 2 other 0.035 J-wires in anticipation of doing the Bi-V AICD. The pocket was then created in the usual fashion and we advanced the right ventricular lead over a peel-away sheath. This was advanced into the right ventricle. As soon as the right ventricular lead got into the right ventricle, we started seeing some PVCs and then the patient went into V-tach. We cardioverted him but the patient had refractory V-tach which degenerated into ventricular fibrillation. A code was initiated. The patient was intubated. CPR started and advanced ACLS protocol was done. Despite aggressive treatment the patient remained in ventricular fibrillation. IV epi, lidocaine, amiodarone, procainamide, magnesium, bicarb were given with no significant results. CPR was continued throughout the code and I refer you to the code note for full details. Approximately 35 minutes into the code it appeared that the patient had severe refracroty arrhythmias not responding to all modalities of treatment. It was decided to give IV Lopressor and with this the patient was able to be cardioverted into a sinus rhythm with a blood pressure initially of 70. He was placed on dopamine and the blood pressure quickly rose to over 100. The patient remained intubated. Prior to shocking him we did try to overdrive pace him with the AICD lead but this was unsuccessful as well. In view of this, we aborted the procedure. We removed all the leads and the wires, and the pocket after being cleansed with antibiotic solution was closed in the usual fashion. The patient remained unresponsive and was transferred to the ICU. The family was notified. The patient within hours started waking up and made a full recovery to his preadmission state. I will not recommend to attempt to place another AICD because of the high risk and the refractory nature of the ventricular tachycardia.
Any help would be greatly appreciated! I am just unsure of how to code this!
Thanks!