Shirleybala
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Bilateral infusion cathaters are placed in both legs should i need to code 37201 twice, please confirm.
The patient was placed prone on the angiography table.
Preliminary ultrasound demonstrated thrombus within the bilateral
popliteal veins. The bilateral popliteal regions were prepped and
draped in the usual sterile manner. Local anesthesia was achieved
with 1% lidocaine. Under real-time ultrasound guidance the
bilateral popliteal veins were accessed with a micropuncture set.
A sonographic recording was made for patient's medical record.
Bilateral 9-French sheaths were placed.
Findings:
Contrast was injected demonstrating extensive clot extending from
the bilateral popliteal veins to the inferior vena cava. Clots is
seen extending slightly above the apex of the most inferior
inferior vena cava filter.
Intervention:
Bentson wires were advanced through the sheaths and into the
inferior vena cava, above the IVC filter. Mechanical and
pharmacologic thrombectomy was performed with the Trellis
catheter. On the left the catheter was advanced with proximal
balloon in the inferior vena cava, above the inferior filter.
Four runs were performed, extending down to the popliteal vein,
with a total of 14 mg of TPA. On the right the catheter was
advanced with the proximal balloon in the right common iliac vein.
Three runs were performed, extending down to the popliteal vein,
with a total of 15 mg of TPA. Repeat contrast injection through
both sheaths demonstrated slight improvement with significant
residual thrombus. An Omni flush catheter was advanced to the
level of the inferior vena cava, just above the bifurcation.
Contrast was injected and digital subtraction angiography was
performed demonstrating improvement, however significant residual
thrombus within the inferior vena cava and in the inferior IVC
filter.
At this point there was a discussion with the neuro- ICU attending
and Dr.xxx. Given risks and benefits, it was decided to place
multi-side hole infusion catheters and infused TPA overnight in
order to give patient potential for more complete thrombolysis.
Bilateral Cragg-McNamara infusion catheters, with 50-cm infusion
length, were advanced. On the left the catheter extended from the
apex of the inferior IVC filter to the mid femoral vein. On the
right the catheter extended from the right common iliac vein to
the distal femoral vein, at the level of the distal tibia.
Occlusion wires were placed through the bilateral catheters. TPA
was infused at a concentration of 0.5 mg/hr. Heparinized saline
was infused through the bilateral sheath. The sheaths were
sutured in place. Sterile dressings were applied bilaterally.
Plan is to allow infusion overnight and pull infusion catheters
and sheaths in 24 hours, in the intensive care unit.
Impression:
Bilateral venograms demonstrating extensive thrombus extending
from the bilateral popliteal veins to the inferior vena cava,
above the inferior IVC filter.
Pharmacologic and mechanical thrombectomy performed with the
Trellis catheter and a total of 29 mg TPA. Repeat venogram
demonstrates improvement, however significant residual thrombus
extending from the bilateral popliteal veins to the inferior vena
cava.
Bilateral multi-sidehole infusion catheters placed with 50-cm
infusion length and occlusion wires. Infusion of TPA performed at
0.5 mg/hr.
The patient was placed prone on the angiography table.
Preliminary ultrasound demonstrated thrombus within the bilateral
popliteal veins. The bilateral popliteal regions were prepped and
draped in the usual sterile manner. Local anesthesia was achieved
with 1% lidocaine. Under real-time ultrasound guidance the
bilateral popliteal veins were accessed with a micropuncture set.
A sonographic recording was made for patient's medical record.
Bilateral 9-French sheaths were placed.
Findings:
Contrast was injected demonstrating extensive clot extending from
the bilateral popliteal veins to the inferior vena cava. Clots is
seen extending slightly above the apex of the most inferior
inferior vena cava filter.
Intervention:
Bentson wires were advanced through the sheaths and into the
inferior vena cava, above the IVC filter. Mechanical and
pharmacologic thrombectomy was performed with the Trellis
catheter. On the left the catheter was advanced with proximal
balloon in the inferior vena cava, above the inferior filter.
Four runs were performed, extending down to the popliteal vein,
with a total of 14 mg of TPA. On the right the catheter was
advanced with the proximal balloon in the right common iliac vein.
Three runs were performed, extending down to the popliteal vein,
with a total of 15 mg of TPA. Repeat contrast injection through
both sheaths demonstrated slight improvement with significant
residual thrombus. An Omni flush catheter was advanced to the
level of the inferior vena cava, just above the bifurcation.
Contrast was injected and digital subtraction angiography was
performed demonstrating improvement, however significant residual
thrombus within the inferior vena cava and in the inferior IVC
filter.
At this point there was a discussion with the neuro- ICU attending
and Dr.xxx. Given risks and benefits, it was decided to place
multi-side hole infusion catheters and infused TPA overnight in
order to give patient potential for more complete thrombolysis.
Bilateral Cragg-McNamara infusion catheters, with 50-cm infusion
length, were advanced. On the left the catheter extended from the
apex of the inferior IVC filter to the mid femoral vein. On the
right the catheter extended from the right common iliac vein to
the distal femoral vein, at the level of the distal tibia.
Occlusion wires were placed through the bilateral catheters. TPA
was infused at a concentration of 0.5 mg/hr. Heparinized saline
was infused through the bilateral sheath. The sheaths were
sutured in place. Sterile dressings were applied bilaterally.
Plan is to allow infusion overnight and pull infusion catheters
and sheaths in 24 hours, in the intensive care unit.
Impression:
Bilateral venograms demonstrating extensive thrombus extending
from the bilateral popliteal veins to the inferior vena cava,
above the inferior IVC filter.
Pharmacologic and mechanical thrombectomy performed with the
Trellis catheter and a total of 29 mg TPA. Repeat venogram
demonstrates improvement, however significant residual thrombus
extending from the bilateral popliteal veins to the inferior vena
cava.
Bilateral multi-sidehole infusion catheters placed with 50-cm
infusion length and occlusion wires. Infusion of TPA performed at
0.5 mg/hr.
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