Maricela123@gmail.com
Contributor
I need asssitance in coding the following scenario.
Preoperative diagnosis:
Occluded left brachiocephalic stent. Malfunction of the AV fistula._.
Postoperative diagnosis: The same_.
Procedure: Unsuccessful attempt to recanalize left brachiocephalic Smart stent. Conscious sedation, > 45 min.
Findings: Unable to recanalize the stent after multiple attempts with different wires and catheters. I was able to advance the wire up to the most distal end of the stent, however was not able to penetrate it.
Indications: 35-year-old male_ with a clinical picture of occluded brachiocephalic stent
Details of the procedure: The patient was identified in the holding area and brought to the operating room and positioned supine on the operating table. Sequential compression devices were applied to bilateral lower extremities to prevent deep venous thromboembolism. Sedation was initiated without any complications. Versed and fentanyl was given. The surgical area was prepped and draped in a regular sterile fashion.
TIME OUT: Immediately prior to procedure, time out was performed to include correct patient, agreement on the procedure to be performed, correct side, site, position, accurate procedure consent, relevant images, antibiotics, fluids. Everybody agreed. *** Ultrasound of the right groin was performed and femoral vein was identified. It was punctured under ultrasound guidance with direct visualization of the needle entry. The Magic torque O 35 wire was advanced from the femoral vein into the IVC, through the right heart into the SVC and subsequently into the left brachiocephalic vein. Then the glide catheter was advanced over the wire and positioned into the proximal brachiocephalic vein. Angled Glidewire was used to penetrate into the stent. X-ray in multiple projections were taken and location of the wire in the stent was confirmed. Then I placed Terumo destination sheath 65 cm for more support and attempted to recanalize the stent using combination of Glidewire, advantage wire, different catheters. Nothing worked. There was enough support. Subsequently, I used 90 cm performer sheath and parked it inside the stent. Having more support I was able to penetrate stent of the stent length. However, after spending at least 20 minutes into able to penetrate the last distal middle of the stent and get into the subclavian vein. After multiple attempts failed, the procedure was aborted. All the support devices were removed and the pressure was held over the femoral vein for 5 minutes.
The needle, instrument and sponge counts were correct x 2. The patient tolerated the procedure well, was extubated in the OR and was transferred to the recovery in stable condition.
Preoperative diagnosis:
Occluded left brachiocephalic stent. Malfunction of the AV fistula._.
Postoperative diagnosis: The same_.
Procedure: Unsuccessful attempt to recanalize left brachiocephalic Smart stent. Conscious sedation, > 45 min.
Findings: Unable to recanalize the stent after multiple attempts with different wires and catheters. I was able to advance the wire up to the most distal end of the stent, however was not able to penetrate it.
Indications: 35-year-old male_ with a clinical picture of occluded brachiocephalic stent
Details of the procedure: The patient was identified in the holding area and brought to the operating room and positioned supine on the operating table. Sequential compression devices were applied to bilateral lower extremities to prevent deep venous thromboembolism. Sedation was initiated without any complications. Versed and fentanyl was given. The surgical area was prepped and draped in a regular sterile fashion.
TIME OUT: Immediately prior to procedure, time out was performed to include correct patient, agreement on the procedure to be performed, correct side, site, position, accurate procedure consent, relevant images, antibiotics, fluids. Everybody agreed. *** Ultrasound of the right groin was performed and femoral vein was identified. It was punctured under ultrasound guidance with direct visualization of the needle entry. The Magic torque O 35 wire was advanced from the femoral vein into the IVC, through the right heart into the SVC and subsequently into the left brachiocephalic vein. Then the glide catheter was advanced over the wire and positioned into the proximal brachiocephalic vein. Angled Glidewire was used to penetrate into the stent. X-ray in multiple projections were taken and location of the wire in the stent was confirmed. Then I placed Terumo destination sheath 65 cm for more support and attempted to recanalize the stent using combination of Glidewire, advantage wire, different catheters. Nothing worked. There was enough support. Subsequently, I used 90 cm performer sheath and parked it inside the stent. Having more support I was able to penetrate stent of the stent length. However, after spending at least 20 minutes into able to penetrate the last distal middle of the stent and get into the subclavian vein. After multiple attempts failed, the procedure was aborted. All the support devices were removed and the pressure was held over the femoral vein for 5 minutes.
The needle, instrument and sponge counts were correct x 2. The patient tolerated the procedure well, was extubated in the OR and was transferred to the recovery in stable condition.