Can we code the below procedure with
36569
36000-5950
76937-26
75822-26.
After obtaining informed, written consent the patient was placed
in the supine position and the right arm region was prepped and
draped in the usual sterile fashion.
After the administration of local anesthesia and under ultrasound
guidance, a brachial vein was then accessed several cm above the
elbow using a 21 gauge micropuncture needle. An 018 inch
guidewire was advanced through the needle and into the vein but
multiple attempts to advance a wire centrally were unsuccessful.
The needle was exchanged for a 5.5 French sheath. A gentle
injection of contrast and performed which demonstrated narrowing
and tortuosity of the brachial vein. Multiple attempts to advance
and 018 Glidewire beyond the tortuous vein and into the central
veins of the chest were unsuccessful. The sheath was removed and
hemostasis obtained with direct manual compression. A sterile
dressing was applied over the skin entry site.
The left arm region was then prepped and draped in the usual
sterile fashion.
After the administration of local anesthesia and under ultrasound
guidance, a brachial vein was accessed several centimeters above
the elbow using a 21-gauge micropuncture needle. An 018 inch
guidewire was advanced through the needle and into the vein and
advanced centrally. The needle was removed and exchanged for a
5.5 French peel-away sheath. A 5 French single lumen Power PICC
line was cut to 41 cm in length and advanced through the peel-away
sheath but failed to advance beyond the humeral head. The PICC
line was pulled back and a gentle injection of contrast was
performed. This demonstrated occlusion of the central brachial
veins with filling of collateral vessels which appeared to empty
into the central basilic vein/axillary vein. An area of
extravasation just central to the skin entry site was identified.
The wire and peel-away sheath were removed. Hemostasis was
obtained with direct manual compression.
After the administration of local anesthesia and under ultrasound
guidance, the basilic vein was accessed several centimeters above
the elbow using 21-gauge micropuncture needle. An 018 inch
guidewire was advanced through the needle and advanced centrally.
The needle was removed and exchanged for a 5.5-French peel-away
sheath. A 5-French single lumen power PICC line was cut to 39 cm
in length, advanced through the peel-away sheath and positioned at
the atrial caval junction. The peel away sheath was then removed.
Post procedure imaging of the chest was performed demonstrating
the distal catheter tip overlying at the atrial caval junction in
good position.
Impression:
Successful placement of a 5 French single lumen Power PICC line
via the left basilic vein as described above.
Narrowing and tortuosity of the right brachial vein with
unsuccessful attempt to advance an 018 wire centrally into the
draining veins of the chest as described above.
Occlusion of the central left brachial veins with filling of
multiple collateral veins which empty into the central basilic
vein/axillary vein as described above.
36569
36000-5950
76937-26
75822-26.
After obtaining informed, written consent the patient was placed
in the supine position and the right arm region was prepped and
draped in the usual sterile fashion.
After the administration of local anesthesia and under ultrasound
guidance, a brachial vein was then accessed several cm above the
elbow using a 21 gauge micropuncture needle. An 018 inch
guidewire was advanced through the needle and into the vein but
multiple attempts to advance a wire centrally were unsuccessful.
The needle was exchanged for a 5.5 French sheath. A gentle
injection of contrast and performed which demonstrated narrowing
and tortuosity of the brachial vein. Multiple attempts to advance
and 018 Glidewire beyond the tortuous vein and into the central
veins of the chest were unsuccessful. The sheath was removed and
hemostasis obtained with direct manual compression. A sterile
dressing was applied over the skin entry site.
The left arm region was then prepped and draped in the usual
sterile fashion.
After the administration of local anesthesia and under ultrasound
guidance, a brachial vein was accessed several centimeters above
the elbow using a 21-gauge micropuncture needle. An 018 inch
guidewire was advanced through the needle and into the vein and
advanced centrally. The needle was removed and exchanged for a
5.5 French peel-away sheath. A 5 French single lumen Power PICC
line was cut to 41 cm in length and advanced through the peel-away
sheath but failed to advance beyond the humeral head. The PICC
line was pulled back and a gentle injection of contrast was
performed. This demonstrated occlusion of the central brachial
veins with filling of collateral vessels which appeared to empty
into the central basilic vein/axillary vein. An area of
extravasation just central to the skin entry site was identified.
The wire and peel-away sheath were removed. Hemostasis was
obtained with direct manual compression.
After the administration of local anesthesia and under ultrasound
guidance, the basilic vein was accessed several centimeters above
the elbow using 21-gauge micropuncture needle. An 018 inch
guidewire was advanced through the needle and advanced centrally.
The needle was removed and exchanged for a 5.5-French peel-away
sheath. A 5-French single lumen power PICC line was cut to 39 cm
in length, advanced through the peel-away sheath and positioned at
the atrial caval junction. The peel away sheath was then removed.
Post procedure imaging of the chest was performed demonstrating
the distal catheter tip overlying at the atrial caval junction in
good position.
Impression:
Successful placement of a 5 French single lumen Power PICC line
via the left basilic vein as described above.
Narrowing and tortuosity of the right brachial vein with
unsuccessful attempt to advance an 018 wire centrally into the
draining veins of the chest as described above.
Occlusion of the central left brachial veins with filling of
multiple collateral veins which empty into the central basilic
vein/axillary vein as described above.
