margaret fahy
Guru
Hey Guys,
I have one where the central line is inserted via the saphenous vein....as saphenous is a peripheral insertion, which code would i use...36557 is a central insertion....so not sure what to use for this.
PROCEDURE: A limited ultrasound of the right groin was performed
to choose a site for insertion of the PICC. The right femoral
vein was chosen, and the skin overlying site was marked. The
skin of the right thigh was prepped and draped in sterile
fashion. Using real-time ultrasound guidance, the right greater
saphenous vein was punctured with a 21-gauge needle from the
lower thigh via a thigh subcutaneous tunnel with a 21g needle
into the left saphenous vein at the mid thigh. Once venous blood
was obtained a 0.014" Nitrex wire was placed into the vein and
advanced to the right atrium. A small dermatotomy was made, the
tract was dilated, and a 3 F peel-away sheath was placed into the
vein via the subcutaneous tunnel. The distance to the
cavo-atrial junction was measured and a 2.6 F lumen PICC was cut
to 21 cm. Via the peel-away sheath, with the PICC loaded on a
0.010" wire; the PICC was placed into the vein and advanced with
fluoroscopic guidance until the tip was at the upper IVC. The
peel-away sheath was then removed. The catheter was fixed to the
skin with a Stat-Lock device, and a sterile occlusive dressing
was applied. The catheter aspirated and flushed easily and was
heparinized. There were no complications, and the patient left
the IR suite in stable condition. Dr. was present for the
entire procedure.
FINDINGS: A limited ultrasound of the right groin showed a patent
right greater saphenous vein. A fluoroscopic image taken at the
end of the procedure showed the catheter tip to be at the upper
IVC. Initial attempts at accessing the RUE veins failed due to
spasm and thrombosis of the largest vein, the right basilic vein.
Permanent ultrasound and fluoroscopic images were obtained and
stored in the PACS system.
IMPRESSION
Successful placement of a 21 cm, 2.6 F double lumen
tunneled PICC via the right greater saphenous vein with tip at
the upper IVC.
I have one where the central line is inserted via the saphenous vein....as saphenous is a peripheral insertion, which code would i use...36557 is a central insertion....so not sure what to use for this.
PROCEDURE: A limited ultrasound of the right groin was performed
to choose a site for insertion of the PICC. The right femoral
vein was chosen, and the skin overlying site was marked. The
skin of the right thigh was prepped and draped in sterile
fashion. Using real-time ultrasound guidance, the right greater
saphenous vein was punctured with a 21-gauge needle from the
lower thigh via a thigh subcutaneous tunnel with a 21g needle
into the left saphenous vein at the mid thigh. Once venous blood
was obtained a 0.014" Nitrex wire was placed into the vein and
advanced to the right atrium. A small dermatotomy was made, the
tract was dilated, and a 3 F peel-away sheath was placed into the
vein via the subcutaneous tunnel. The distance to the
cavo-atrial junction was measured and a 2.6 F lumen PICC was cut
to 21 cm. Via the peel-away sheath, with the PICC loaded on a
0.010" wire; the PICC was placed into the vein and advanced with
fluoroscopic guidance until the tip was at the upper IVC. The
peel-away sheath was then removed. The catheter was fixed to the
skin with a Stat-Lock device, and a sterile occlusive dressing
was applied. The catheter aspirated and flushed easily and was
heparinized. There were no complications, and the patient left
the IR suite in stable condition. Dr. was present for the
entire procedure.
FINDINGS: A limited ultrasound of the right groin showed a patent
right greater saphenous vein. A fluoroscopic image taken at the
end of the procedure showed the catheter tip to be at the upper
IVC. Initial attempts at accessing the RUE veins failed due to
spasm and thrombosis of the largest vein, the right basilic vein.
Permanent ultrasound and fluoroscopic images were obtained and
stored in the PACS system.
IMPRESSION
Successful placement of a 21 cm, 2.6 F double lumen
tunneled PICC via the right greater saphenous vein with tip at
the upper IVC.