calorom2
Networker
Can someone please give me some guidance with coding this note?
PROCEDURES PERFORMED:
1. Ultrasound guided access, right common femoral artery and right
common femoral vein.
2. Right innominate artery into subclavian angiogram.
3. Left subclavian axillary angiogram.
4. Distal aortogram.
5. Bilateral iliac angiograms into the right and left common femoral
arteries.
COMPLICATIONS:
None.
TOTAL CONTRAST USED:
50 mL.
DESCRIPTION OF PROCEDURE:
The risks and benefits of cardiac catheterization was discussed with
the patient. He is agreeable to the procedure. Consent was obtained.
Time-out was performed. The patient, procedure, and position were identified.
The patient was given Versed 1 mg and fentanyl 50 mcg before the procedure
for conscious sedation.
The patient was prepped and draped in the normal fashion. Ultrasound
guidance was used to identify the right common femoral artery. Using
micropuncture technique, the artery was accessed and a 7-French sheath
was introduced without difficulty. Using the same modified Seldinger
technique with ultrasound guidance. The right common femoral vein was
accessed and a 6-French sheath introduced without difficulty. A 6-French
JR4 guide catheter was used for the angiogram. Distal aortogram showed
no abdominal aortic aneurysm. The left common iliac has heavy calcification
and 60% to 70% stenosis. Heavy calcification is noted to extend into
the common femoral artery. This vessel is not approachable for Impella
insertion. The right common iliac was somewhat tortuous and heavily
calcified. The right common femoral artery also has heavy calcification.
This vessel also was not a ideal vessel for cannulation for the Impella
pump.
Our attention was directed to the innominate and subclavian artery.
The JR4 catheter was advanced into the innominate artery and angiogram
showed a large vessel. There was a notch at the clavicular and 1st
rib junction.
Left subclavian angiogram showed to be large patent vessel. There was
no significant calcification or stenosis at the ostium of the subclavian
artery. The axillary artery also was without significant disease or
calcification. There was no significant notch or shelf at the clavicular
1st rib junction. This was an ideal site for Impella insertion
At the end of the procedure, the sheath was sutured in place and the
patient transferred to the intensive care unit in stable condition.
PROCEDURES PERFORMED:
1. Ultrasound guided access, right common femoral artery and right
common femoral vein.
2. Right innominate artery into subclavian angiogram.
3. Left subclavian axillary angiogram.
4. Distal aortogram.
5. Bilateral iliac angiograms into the right and left common femoral
arteries.
COMPLICATIONS:
None.
TOTAL CONTRAST USED:
50 mL.
DESCRIPTION OF PROCEDURE:
The risks and benefits of cardiac catheterization was discussed with
the patient. He is agreeable to the procedure. Consent was obtained.
Time-out was performed. The patient, procedure, and position were identified.
The patient was given Versed 1 mg and fentanyl 50 mcg before the procedure
for conscious sedation.
The patient was prepped and draped in the normal fashion. Ultrasound
guidance was used to identify the right common femoral artery. Using
micropuncture technique, the artery was accessed and a 7-French sheath
was introduced without difficulty. Using the same modified Seldinger
technique with ultrasound guidance. The right common femoral vein was
accessed and a 6-French sheath introduced without difficulty. A 6-French
JR4 guide catheter was used for the angiogram. Distal aortogram showed
no abdominal aortic aneurysm. The left common iliac has heavy calcification
and 60% to 70% stenosis. Heavy calcification is noted to extend into
the common femoral artery. This vessel is not approachable for Impella
insertion. The right common iliac was somewhat tortuous and heavily
calcified. The right common femoral artery also has heavy calcification.
This vessel also was not a ideal vessel for cannulation for the Impella
pump.
Our attention was directed to the innominate and subclavian artery.
The JR4 catheter was advanced into the innominate artery and angiogram
showed a large vessel. There was a notch at the clavicular and 1st
rib junction.
Left subclavian angiogram showed to be large patent vessel. There was
no significant calcification or stenosis at the ostium of the subclavian
artery. The axillary artery also was without significant disease or
calcification. There was no significant notch or shelf at the clavicular
1st rib junction. This was an ideal site for Impella insertion
At the end of the procedure, the sheath was sutured in place and the
patient transferred to the intensive care unit in stable condition.