carriebeth
Networker
Hello I an an IR coder (primarly vascular) & not at all familiar with this case. Any help anyone?! Please!!
The patient was placed supine on the fluoroscopy table. The nasopharynx was anesthetized with 3cc vaporized lidocaine 1% on each side.
The sphenocath was advanced above the middle turbinate of the right nostril under the guidance of both AP and lateral fluoroscopy. To ensure proper placement of medication the inner catheter was deployed through the outer catheter of the sphenocath. This allows the tip of the catheter to advance above and beyond the anterior border of the middle turbinate. This placed the catheter tip in an optimal position above the pterygopalatine fossa/canal. Isovue M200 x 3ml was then injected and through fluoroscopic vision demonstrated adequate coverage of the posterior nasopharynx, with pooling of medication in the sphenoethmoid recess and pterygopalatine canal (greater palatine canal). No obstruction was identified. Lidocaine 4% x 2.5ml was then injected as the patient was asked to inhale through the nose.
The sphenocath was advanced above the middle turbinate of the left nostril under the guidance of both AP and lateral fluoroscopy. To ensure proper placement of medication the inner catheter was deployed through the outer catheter of the sphenocath. This allows the tip of the catheter to advance above and beyond the anterior border of the middle turbinate. This placed the catheter tip in an optimal position above the pterygopalatine fossa/canal. Isovue M200 x 3ml was then injected and through fluoroscopic vision demonstrated adequate coverage of the posterior nasopharynx, with pooling of medication in the sphenoethmoid recess and pterygopalatine canal (greater palatine canal). No obstruction was identified. Lidocaine 4% x 2.5ml was then injected as the patient was asked to inhale through the nose.
The patient tolerated the procedure well and was discharged in satisfactory condition.
The patient had a pain score of --/10 prior to the procedure, and a --/10 after the procedure.
PLAN:
Follow-up in 2-4 weeks for evaluation of treatment and to assess the long term efficacy of today's procedure. The patient was instructed to call immediately if any of the following develops; new neurological symptoms, fever, increased pain, uncontrolled epistaxis, or any other worrisome symptoms.
The patient was placed supine on the fluoroscopy table. The nasopharynx was anesthetized with 3cc vaporized lidocaine 1% on each side.
The sphenocath was advanced above the middle turbinate of the right nostril under the guidance of both AP and lateral fluoroscopy. To ensure proper placement of medication the inner catheter was deployed through the outer catheter of the sphenocath. This allows the tip of the catheter to advance above and beyond the anterior border of the middle turbinate. This placed the catheter tip in an optimal position above the pterygopalatine fossa/canal. Isovue M200 x 3ml was then injected and through fluoroscopic vision demonstrated adequate coverage of the posterior nasopharynx, with pooling of medication in the sphenoethmoid recess and pterygopalatine canal (greater palatine canal). No obstruction was identified. Lidocaine 4% x 2.5ml was then injected as the patient was asked to inhale through the nose.
The sphenocath was advanced above the middle turbinate of the left nostril under the guidance of both AP and lateral fluoroscopy. To ensure proper placement of medication the inner catheter was deployed through the outer catheter of the sphenocath. This allows the tip of the catheter to advance above and beyond the anterior border of the middle turbinate. This placed the catheter tip in an optimal position above the pterygopalatine fossa/canal. Isovue M200 x 3ml was then injected and through fluoroscopic vision demonstrated adequate coverage of the posterior nasopharynx, with pooling of medication in the sphenoethmoid recess and pterygopalatine canal (greater palatine canal). No obstruction was identified. Lidocaine 4% x 2.5ml was then injected as the patient was asked to inhale through the nose.
The patient tolerated the procedure well and was discharged in satisfactory condition.
The patient had a pain score of --/10 prior to the procedure, and a --/10 after the procedure.
PLAN:
Follow-up in 2-4 weeks for evaluation of treatment and to assess the long term efficacy of today's procedure. The patient was instructed to call immediately if any of the following develops; new neurological symptoms, fever, increased pain, uncontrolled epistaxis, or any other worrisome symptoms.