Case 6-2 LOCATION: Inpatient, Hospital PATIENT: Tim Luther ATTENDING/ADMIT PHYSICIAN: Frank Gaul, MD SURGEON: David Barton,...

Case 6-2

LOCATION: Inpatient, Hospital

PATIENT: Tim Luther

ATTENDING/ADMIT PHYSICIAN: Frank Gaul, MD

SURGEON: David Barton, MD

PREOPERATIVE DIAGNOSIS: Fluid overload state, no urine output, acute renal failure.

POSTOPERATIVE DIAGNOSIS: Fluid overload state, no urine output, acute renal failure.

PROCEDURE PERFORMED: Temporary dialysis catheter placement.

PROCEDURE: This 77-year-old patient was brought to the emergency room. The right femoral vein was selected. This was tried with the left IJ vein earlier without success. I reserved the right IJ for a central line that will be placed by interventional radiology in the morning. The right femoral vein was localized using ultrasound. (The ultrasound is not a reportable service.) The area was prepped in the usual fashion. One-percent lidocaine was used for local anesthesia. The right femoral vein was accessed under real-time ultrasound guidance without difficulty. The guidewire was advanced smoothly. The hook needle was taken out. The right femoral vein was dilated. An 11.5 French 16-cm temporary dialysis catheter with a straight extension was advanced to the iliac vein through the right femoral vein over the guidewire using the Seldinger technique without difficulty. Both ports had good venous blood return. Both ports were flushed with saline and heparin. The catheter was secured to the skin. The patient tolerated the procedure very well without immediate complication. Dialysis will be done semi-urgently.

CPT Code(s): _________________

ICD-10-CM Code(s): ________________

Abstracting Questions:

1. What is another name for a catheter or central line?

2. What vessel was used for the access point for the catheter?

3. Was the insertion central or peripheral?

Expert Solution

1. It also named as PICC line insertion which is a line use for long term course.

2. The major veins such as brachial femoral are usually chosen for the insertion here it was femoral

3. Even it using a vein it considered as a Central vein catheterization

Nightingale answered 2 years ago

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