Would you bill for attemepted left side access? If so what? Thanks, Sue

PICC line insertion.

History: 7-year-old female who had ruptured appendicitis. She is receiving antibiotics postoperatively. We have been asked to place a PICC line.

Time out procedure was performed. She was prepped and draped in the usual sterile fashion. Maximum sterile barrier technique was used. General anesthesia was used for the procedure.

I initially attempted to access the cephalic vein in the left arm using ultrasound guidance. Local anesthesia was provided using lidocaine. Attempt on the left side was unsuccessful. The basilic vein in the left arm was then attempted and this was also unsuccessful.

We abandoned attempted access in the left arm and attention was paid to the right arm. Right arm was prepped and draped in the usual sterile fashion. Maximum sterile barrier technique was used. Fluoroscopic guidance was used during placement of a PICC line on the right. Contrast was injected through a previously placed IV in the right hand. The basilic vein was accessed. A 4-French single lumen PICC line was cut to 35 cm in length. It was advanced under fluoroscopic guidance into the superior vena cava. Spot film at the end of the procedure documented catheter tip at the atriocaval junction.

Result Impression
Attempted placement of a PICC line from a left upper extremity approach using ultrasound guidance was unsuccessful. A right-sided PICC line was then successfully placed using fluoroscopic guidance.