Hello All!
I am stuck on this one: After much manipulation the new lead could not be placed. What I think the codes should be are at the bottom. Thanks for any thoughts!
PROCEDURE PERFORMED:
1. Dual chamber permanent pacemaker generator change.
2. Attempted RV lead placement.
INDICATION FOR PROCEDURES: End of battery life status.
COMPLICATIONS: None.
DESCRIPTION OF PROCEDURE: The patient was brought to the Cath Lab after informed and signed consent was obtained. The left subclavian area was draped and prepped in a sterile surgical fashion. The patient received IV antibiotics per protocol. The left subclavian artery was
infiltrated with 2% Xylocaine with epinephrine with careful dissection to avoid any trauma to the exiting leads and existing device, the pocket was opened and the device was removed from the pocket. Vascular access was then obtained with a long introducer sheath to overcome a stenosis in the left subclavian vein. A right ventricular lead was placed despite extensive
mapping in 7 or 8 different positions. We were not able to obtain pacing and sensing thresholds any better than the existing right ventricular lead. After an exhaustive amount of time finding a reasonable pacing sensing site, the decision was made to remove the new lead, connect the device to the old lead and the prior atrial lead, as well. The device was placed
in the pocket after the pocket was extended to accommodate the larger device. The pocket was then closed in a 3-layered fashion, with excellent hemostasis and wound approximation.
MATERIALS USED:
1. The new device implant is a Boston Scientific Accolade DR. Model number is L301, serial number is 703556.
2. The existing right atrial lead is a Biotronik device/lead. The model number is 343081, serial number is 24043972.
3. The right ventricular lead is a Biotronik model number 343081, serial number is 24124853.
INITIAL MEASURED DATA:
1. The right atrial T-wave sensing is 2.6 millivolts with a pacing threshold of 0.7 at 0.4 msec with a lead resistance of 451 ohms at a current of 1.6 milliamps.
2. The right atrial R-wave sensing cannot be obtained due to 100% pacemaker dependent. The pacing threshold was 1.8 volts at 0.4 milliseconds with a lead impedance of 403 ohms.
INITIAL PROGRAM PARAMETERS: The device is programmed in a DDDR mode with a lower rate limit of 70, upper rate limit of 130.
CONCLUSIONS:
1. A dual chamber permanent pacemaker generator change. Note that a right ventricular lead was attempted to be placed but could not find acceptable pacing thresholds that were any better than the existing right ventricular lead. Note the new device which has autocapture. The estimated duration of the battery status on this device will be approximately 7 years.
2. The patient will be admitted to the hospital for further observation and evaluation. I will anticipate discharge to home tomorrow morning.
33233
33234
33208
33225-52
or
33228
33225-52
Jennifer Everett, CPC
I am stuck on this one: After much manipulation the new lead could not be placed. What I think the codes should be are at the bottom. Thanks for any thoughts!
PROCEDURE PERFORMED:
1. Dual chamber permanent pacemaker generator change.
2. Attempted RV lead placement.
INDICATION FOR PROCEDURES: End of battery life status.
COMPLICATIONS: None.
DESCRIPTION OF PROCEDURE: The patient was brought to the Cath Lab after informed and signed consent was obtained. The left subclavian area was draped and prepped in a sterile surgical fashion. The patient received IV antibiotics per protocol. The left subclavian artery was
infiltrated with 2% Xylocaine with epinephrine with careful dissection to avoid any trauma to the exiting leads and existing device, the pocket was opened and the device was removed from the pocket. Vascular access was then obtained with a long introducer sheath to overcome a stenosis in the left subclavian vein. A right ventricular lead was placed despite extensive
mapping in 7 or 8 different positions. We were not able to obtain pacing and sensing thresholds any better than the existing right ventricular lead. After an exhaustive amount of time finding a reasonable pacing sensing site, the decision was made to remove the new lead, connect the device to the old lead and the prior atrial lead, as well. The device was placed
in the pocket after the pocket was extended to accommodate the larger device. The pocket was then closed in a 3-layered fashion, with excellent hemostasis and wound approximation.
MATERIALS USED:
1. The new device implant is a Boston Scientific Accolade DR. Model number is L301, serial number is 703556.
2. The existing right atrial lead is a Biotronik device/lead. The model number is 343081, serial number is 24043972.
3. The right ventricular lead is a Biotronik model number 343081, serial number is 24124853.
INITIAL MEASURED DATA:
1. The right atrial T-wave sensing is 2.6 millivolts with a pacing threshold of 0.7 at 0.4 msec with a lead resistance of 451 ohms at a current of 1.6 milliamps.
2. The right atrial R-wave sensing cannot be obtained due to 100% pacemaker dependent. The pacing threshold was 1.8 volts at 0.4 milliseconds with a lead impedance of 403 ohms.
INITIAL PROGRAM PARAMETERS: The device is programmed in a DDDR mode with a lower rate limit of 70, upper rate limit of 130.
CONCLUSIONS:
1. A dual chamber permanent pacemaker generator change. Note that a right ventricular lead was attempted to be placed but could not find acceptable pacing thresholds that were any better than the existing right ventricular lead. Note the new device which has autocapture. The estimated duration of the battery status on this device will be approximately 7 years.
2. The patient will be admitted to the hospital for further observation and evaluation. I will anticipate discharge to home tomorrow morning.
33233
33234
33208
33225-52
or
33228
33225-52
Jennifer Everett, CPC
Pacemaker gen change with failed lead replacement
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