Insertion of a left subclavian vein introducer sheaths/intravenous Cordis

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#1. Insertion of a left subclavian vein introducer sheaths/intravenous Cordis.
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Cardiologist has recommended and requested cardiothoracic surgery to obtain central venous axis and Swan-Ganz catheter for assistance in managing this patient's critical care status. This request has been reviewed with Dr. Lico who concurs with above plans. Informed consent has been obtained from the patient's spouse via telephone. This included risks and benefits to procedure which include but not limited to bleeding, infection and cardiac arrhythmia.

Patient's left subclavian region was prepped with antiseptic solution and standard sterile draping was applied. Strict aseptic technique was utilized throughout procedure. Approximately 5 mL 1% local lidocaine was used to infiltrate the soft tissue over the mid left subclavian region. At this point a large bore needle was used to gain access to the left subclavian vein with dark venous nonpulsatile blood aspirate obtained. Guard wire was then passed into the left subclavian vein and advanced and the large bore needle withdrawn. At this point a multilumen central venous introducer sheath/CORDIS was placed over the guidewire and advanced into the left subclavian vein. The guidewire was then withdrawn. All two ports on the introducer sheath were then aspirated for dark nonpulsatile venous blood. Both ports were then flushed clear with sterile normal saline. The introducer sheath was then suture secured to the skin.
 

conleyclan

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This procedure is normally done by anesthesia. When billing for anesthesia you cannot bill for the placement of the CVP. They consider the CVP the introducer for a swan-ganz catheter. You would only bill for the CORDIS which is the swan-ganz 93503.
 
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