calorom2
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Can someone with code suggestions for these notes? I've not previously encountered aspirations these so they are new for me. They were both done on the same patient on the same day.
Thank you.
Procedure A:
PROCEDURES:
1. Ultrasound-guided access of the left lesser saphenous vein.
2. Penumbra aspiration of the left popliteal vein and left superficial femoral vein.
INDICATION:
DVT with pulmonary embolism. Severe left lower extremity edema.
DESCRIPTION OF PROCEDURE:
The risks and benefits of all left DVT, aspiration by Penumbra catheter aspiration was discussed with the patient. He was agreeable to the procedure. Consent was obtained.
Time-out was performed. The patient, procedure, and physician were identified.
He 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 was used to assess the patency of the left posterior tibial vein. The vein was patent and noncompressible. The lesser saphenous vein was identified and accessed with ultrasound guidance. The vessel was patent and without thrombus. A Prowater was advanced past the popliteal vein into the superficial femoral vein. Peripheral venography showed large thrombus burden from the popliteal vein all the way up to the superficial femoral vein. A 6-French sheath was inserted over the wire. A #6 Penumbra catheter was advanced with aspiration all the way up to the proximal superficial femoral vein. The catheter became occluded with multiple thrombus. We up-sized the sheath to an 8-French sheath and a CAT8 catheter was used to aspirate large amounts of thrombus from the popliteal vein all the way up to the proximal superficial femoral vein. The patient was given heparin 2000 units during the procedure. The ACT was 250 seconds. Total contrast used was 20 mL.
IMPRESSION:
Successful thrombus aspiration of the left lower extremity deep vein thrombosis from the proximal superficial femoral vein down to the popliteal vein.
Procedure B:
PROCEDURES:
1. Ultrasound guided access, right internal jugular vein.
2. Penumbra pulmonary aspiration of the right and left pulmonary artery.
3. Right heart catheterization.
INDICATION:
Submassive PE with large thrombus burden load, symptomatic shortness of breath, abnormal echo and hypotension.
DESCRIPTION OF PROCEDURE:
The risks and benefits of pulmonary artery thrombus aspiration was discussed with the patient and he was agreeable to the procedure. Consent was obtained.
Time-out was performed. The patient, procedure, and physician were identified.
He 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. 1% lidocaine was generously infiltrated into the right anterolateral neck region. Ultrasound was used to assess the patency of the internal jugular vein. The internal jugular vein was large and patent. The right IJ was accessed without difficulty and an 8-French sheath was introduced without difficulty.
Right heart catheterization was performed. Mean RA 10, RV 23/4, mean 6, pulmonary artery 26/10, mean PA pressure 60 mmHg. The pulmonary capillary wedge pressure is 10 mmHg. The Swan-Ganz catheter was exchanged over a long V18 wire. An 8-French 45 cm Destination sheath was placed to the main pulmonary artery. A Penumbra CAT8 catheter was placed into the right upper lobe, right middle lobe, and right lower lobe, and aspiration with a separator was performed. Multiple passes were made. The Penumbra catheter was directed to the left upper and lower lobe. Penumbra aspiration and separator aspiration was performed. Multiple clots were noted to be aspirated.
The ending right heart filling pressures, mean RA 5, RV 18/5, PA 19/10, mean PA 14 mmHg. The mean pulmonary capillary wedge pressure was 10 mmHg.
The patient received IV heparin 2000 units x2. The ACT during the procedure was 203 seconds.
At the end of the procedure, the long 8-French Destination sheath was removed and a short 8-French sheath was placed. The sheath was sutured in place. The patient tolerated the procedure well.
Thank you.
Procedure A:
PROCEDURES:
1. Ultrasound-guided access of the left lesser saphenous vein.
2. Penumbra aspiration of the left popliteal vein and left superficial femoral vein.
INDICATION:
DVT with pulmonary embolism. Severe left lower extremity edema.
DESCRIPTION OF PROCEDURE:
The risks and benefits of all left DVT, aspiration by Penumbra catheter aspiration was discussed with the patient. He was agreeable to the procedure. Consent was obtained.
Time-out was performed. The patient, procedure, and physician were identified.
He 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 was used to assess the patency of the left posterior tibial vein. The vein was patent and noncompressible. The lesser saphenous vein was identified and accessed with ultrasound guidance. The vessel was patent and without thrombus. A Prowater was advanced past the popliteal vein into the superficial femoral vein. Peripheral venography showed large thrombus burden from the popliteal vein all the way up to the superficial femoral vein. A 6-French sheath was inserted over the wire. A #6 Penumbra catheter was advanced with aspiration all the way up to the proximal superficial femoral vein. The catheter became occluded with multiple thrombus. We up-sized the sheath to an 8-French sheath and a CAT8 catheter was used to aspirate large amounts of thrombus from the popliteal vein all the way up to the proximal superficial femoral vein. The patient was given heparin 2000 units during the procedure. The ACT was 250 seconds. Total contrast used was 20 mL.
IMPRESSION:
Successful thrombus aspiration of the left lower extremity deep vein thrombosis from the proximal superficial femoral vein down to the popliteal vein.
Procedure B:
PROCEDURES:
1. Ultrasound guided access, right internal jugular vein.
2. Penumbra pulmonary aspiration of the right and left pulmonary artery.
3. Right heart catheterization.
INDICATION:
Submassive PE with large thrombus burden load, symptomatic shortness of breath, abnormal echo and hypotension.
DESCRIPTION OF PROCEDURE:
The risks and benefits of pulmonary artery thrombus aspiration was discussed with the patient and he was agreeable to the procedure. Consent was obtained.
Time-out was performed. The patient, procedure, and physician were identified.
He 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. 1% lidocaine was generously infiltrated into the right anterolateral neck region. Ultrasound was used to assess the patency of the internal jugular vein. The internal jugular vein was large and patent. The right IJ was accessed without difficulty and an 8-French sheath was introduced without difficulty.
Right heart catheterization was performed. Mean RA 10, RV 23/4, mean 6, pulmonary artery 26/10, mean PA pressure 60 mmHg. The pulmonary capillary wedge pressure is 10 mmHg. The Swan-Ganz catheter was exchanged over a long V18 wire. An 8-French 45 cm Destination sheath was placed to the main pulmonary artery. A Penumbra CAT8 catheter was placed into the right upper lobe, right middle lobe, and right lower lobe, and aspiration with a separator was performed. Multiple passes were made. The Penumbra catheter was directed to the left upper and lower lobe. Penumbra aspiration and separator aspiration was performed. Multiple clots were noted to be aspirated.
The ending right heart filling pressures, mean RA 5, RV 18/5, PA 19/10, mean PA 14 mmHg. The mean pulmonary capillary wedge pressure was 10 mmHg.
The patient received IV heparin 2000 units x2. The ACT during the procedure was 203 seconds.
At the end of the procedure, the long 8-French Destination sheath was removed and a short 8-French sheath was placed. The sheath was sutured in place. The patient tolerated the procedure well.