andersonja
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Coding assistance needed:
Procedure Performed: Right arteriovenous fistulogram
Indications: AV fistula which is immature and dysfunctional, unable to be used for hemodialysis.
Anatomical Site: Right arm
Anesthetic: Local
Procedure Steps: Consent obtained from patient. The patient was prepped and draped in sterile fashion. Using 1% lidocaine for local anesthesia, dialysis access was attempted to be cannulated using micropuncture kit. The 21-gauge needle was exchaned over a wire to 5-French catheter in venous direction. A fistulogram was performed which showed that there were multiple collaterals and veins originating around the old graft attachment site.
The rest of the fistula was nicely developed, approx. 8 to 10 mm in diameter. The fistula continued outward as outflow vein. This vein continued as subclavian vein. There was central stenosis of right innominate vein. There was a catheter noted from the left IJ and sitting in the right atrium as well. The inflow could not be assessed as there were multiple branches which were originating close to the inflow. The catheter was removed and hemostasis was achieved by digital pressure. A quick ultrasound was also done which showed that the fistula was deep, more thatn 1 cm throughout the course.
Post Op Condition: Stable
estimated Blood Loss: 5mL.
Specimens: None
Complications: None
Fluids Given: None
Contrast Used: Ominpague 20mL.
Plan:
1. We will not use AV fistula
2. This case will be discussed with the vascular surgeion, regarding the possiblity of any surgical revision.
Thanks in advance to anyone who could assit me with this procedure.
Procedure Performed: Right arteriovenous fistulogram
Indications: AV fistula which is immature and dysfunctional, unable to be used for hemodialysis.
Anatomical Site: Right arm
Anesthetic: Local
Procedure Steps: Consent obtained from patient. The patient was prepped and draped in sterile fashion. Using 1% lidocaine for local anesthesia, dialysis access was attempted to be cannulated using micropuncture kit. The 21-gauge needle was exchaned over a wire to 5-French catheter in venous direction. A fistulogram was performed which showed that there were multiple collaterals and veins originating around the old graft attachment site.
The rest of the fistula was nicely developed, approx. 8 to 10 mm in diameter. The fistula continued outward as outflow vein. This vein continued as subclavian vein. There was central stenosis of right innominate vein. There was a catheter noted from the left IJ and sitting in the right atrium as well. The inflow could not be assessed as there were multiple branches which were originating close to the inflow. The catheter was removed and hemostasis was achieved by digital pressure. A quick ultrasound was also done which showed that the fistula was deep, more thatn 1 cm throughout the course.
Post Op Condition: Stable
estimated Blood Loss: 5mL.
Specimens: None
Complications: None
Fluids Given: None
Contrast Used: Ominpague 20mL.
Plan:
1. We will not use AV fistula
2. This case will be discussed with the vascular surgeion, regarding the possiblity of any surgical revision.
Thanks in advance to anyone who could assit me with this procedure.
