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CODE WITH ICD-10-PCS PLEASE PREOPERATIVE DIAGNOSIS: End-stage renal disease POSTOPERATIVE DIAGNOSIS: End-stage renal disease PROCEDURE: Insertion...

CODE WITH ICD-10-PCS PLEASE

PREOPERATIVE DIAGNOSIS: End-stage renal disease

POSTOPERATIVE DIAGNOSIS: End-stage renal disease

PROCEDURE: Insertion of tunneled central venous hemodialysis catheter, via right femoral vein

ANESTHESIA: IV sedation and local infiltration of 1 percent Xylocaine plus 0.5 percent Marcaine

OPERATIVE FINDINGS: A 35 cm HemoSplit central venous hemodialysis catheter was tunneled to the right femoral vein, had excellent flow from both ports of the catheter, and was adequately irrigated with heparinized saline. No bleeding.

OPERATIVE TECHNIQUE: The patient laid supine on the operating room table. Both femoral areas were prepped and draped in the usual sterile manner. Using 1 percent Xylocaine plus 0.5 percent Marcaine, the right femoral area was infiltrated. A gauge 18 needle was used to cannulate the right femoral vein without difficulty and noted to have excellent flow, and a guidewire was threaded through it. The needle was removed and the site of puncture enlarged with a knife. Another incision was made below the incision. A tunnel was created between these two incisions, and the catheter was tunneled through this area with the Teflon cuff embedded within the subcutaneous tissue of the chest. The dilator and sheath were threaded through the guidewire and directed to the inferior vena cava. The guidewire was removed and the dilator was removed, leaving the sheath behind. Through the sheath, the tunneled catheter was threaded in and directed to the inferior vena cava. The sheath was then removed, and the catheter was aspirated freely of blood and adequately irrigated with heparinized saline. The wound was closed subcuticularly with 4-0 Monocryl, and the catheter was anchored to the skin with the use of a 3-0 nylon and a sterile dressing applied. The patient tolerated the procedure well.

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End stage renal disease N18.6 ,

Z99.2 (use additional code to identify dialysis status )

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