Wiki Fistulogram

nlbarnes

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Escondido, CA
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Surgeon has 36901, 36907, 37607, 35668, 77001-26-59, 76937-26, (I get conflicting info on 76937 which we have documented & stored in patient's records?

Contrast isn't a requirement, is it?

The patient had right neck and chest area as well as left arm prepped and draped in sterile fashion. Ultrasound was used to percutaneously access the internal jugular vein after which guidewire and sheath were placed in the vein without difficulty. An 11 blade was used to create a counterincision at this site, which was dilated with hemostats. At this time, local anesthetic was infiltrated in the right anterior chest wall after which an 11 blade was used to create a stab incision which was dilated with hemostats. The catheter was tunneled from the chest wall incision to the counterincision of the neck without difficulty. The subcutaneous cuff was placed in subcutaneous tract. At this time, a peel-away sheath was tracked over the wire into the internal jugular vein after which catheter was threaded through the sheath without difficulty. The peel-away sheath was removed and fluoroscopy was used to confirm good catheter placement. All ports of the catheter were easily backbled and flushed with heparinized saline followed by filling it with the appropriate amount of concentrated heparin solution. The catheter was then affixed to the chest wall using a 3-0 Prolene suture in a drain stitch fashion. The exit site was dressed with a Biopatch, dry gauze and Tegaderm. The counterincision of the neck was approximated using 4-0 Monocryl in a subcuticular fashion followed by Steri-Strips, Telfa, and Tegaderm. Local anesthetic was infiltrated at the left wrist area after which a #10 blade was used to create a 4cm incision overlying the distal AVF. Blunt and sharp dissection was used to exposed the AVF which was circled with a vessel loop. A micropuncture needle and sheath were inserted into the AVF. A LUE fistulogram was performed as described above. The L sc vein was venoplastied as described above. The patient was given 5000U of heparin prior to venoplasty. After this, the sheath was removed and the fistula was ligated between two vascular clamps and oversewn with 4-0 prolene suture with good hemostasis.

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