suela923@aol.com
Guest
- Messages
- 178
- Best answers
- 0
Are we ever allowed to bill ultrasound with an ureteral stent placement?
Left percutaneous nephrostomy with placement of a left nephroureteral catheter
History: Large left renal pelvis stone causing intermittent obstruction.
Technique: A timeout was performed. The left flank was prepped and draped in sterile fashion. Because of concern for a posterior location of the spleen as demonstrated on the patient's recent CT scan, ultrasound was used in the interventional suite to localize the spleen and attempt needle placement into the left kidney under sonographic guidance. The spleen was well localized. There was no hydronephrosis. The kidney stone was somewhat difficult to see sonographically, and I was not able to engage the collecting system. Images of the kidney were recorded in the permanent medical record with images showing the needle in the vicinity of the renal pelvis. These also demonstrated the spleen anterior and above the site of puncture.
A direct posterior approach was then taken using the stone as a guide. Under fluoroscopic guidance, it was possible to engage the stone with the needle tip and contrast was injected distending the collecting system and demonstrating the ureter. This was then used to provide a target for a second needle from a slightly posterolateral approach. This was again checked with ultrasound to be sure the spleen was not in the way. Fluoroscopic guidance was used to advance these needle into a lower pole infundibulum. This was accomplished successfully. A guidewire was then coiled in the renal pelvis and a Berenstein catheter inserted. This was used to manipulate beyond the stone and into the left ureter. A guidewire was advanced down the left ureter under fluoroscopic guidance. Contrast was injected confirming intraureteral location. Catheter was then fastened in place and the patient sent to the operating room.
Thanks! Sue
Left percutaneous nephrostomy with placement of a left nephroureteral catheter
History: Large left renal pelvis stone causing intermittent obstruction.
Technique: A timeout was performed. The left flank was prepped and draped in sterile fashion. Because of concern for a posterior location of the spleen as demonstrated on the patient's recent CT scan, ultrasound was used in the interventional suite to localize the spleen and attempt needle placement into the left kidney under sonographic guidance. The spleen was well localized. There was no hydronephrosis. The kidney stone was somewhat difficult to see sonographically, and I was not able to engage the collecting system. Images of the kidney were recorded in the permanent medical record with images showing the needle in the vicinity of the renal pelvis. These also demonstrated the spleen anterior and above the site of puncture.
A direct posterior approach was then taken using the stone as a guide. Under fluoroscopic guidance, it was possible to engage the stone with the needle tip and contrast was injected distending the collecting system and demonstrating the ureter. This was then used to provide a target for a second needle from a slightly posterolateral approach. This was again checked with ultrasound to be sure the spleen was not in the way. Fluoroscopic guidance was used to advance these needle into a lower pole infundibulum. This was accomplished successfully. A guidewire was then coiled in the renal pelvis and a Berenstein catheter inserted. This was used to manipulate beyond the stone and into the left ureter. A guidewire was advanced down the left ureter under fluoroscopic guidance. Contrast was injected confirming intraureteral location. Catheter was then fastened in place and the patient sent to the operating room.
Thanks! Sue