Appe Surgical Case #31 Operative Report Diagnosis: Operation: Indications: Hodgk

Question

Appe Surgical Case #31 Operative Report Diagnosis: Operation: Indications: Hodgkin's disease, nonsclerosing type Placement of right subclavian Hickman catheter The patient is a 35-year-old woman with the diagnosis of Her indication for a Hickman catheter was chemotherapy infusion. Hodgkin's disease. Procedure: Thepatientwastakentotheoperatingroomandplacedinthesupineposition.The right chest and subclavian area, neck, and shoulder were prepped and draped in routine manner. A total of 48 cc of 1% Carbocaine without epinephrine was used foranesthesia.The subcutaneous area below the rightclavicle wasnumbed with the lidocaine down to the periosteum. The subclavian vein was stuck with the needle. Good blood flow was returned. The guide wire was passed. At this time, a 2-cm incision was made below the clavicle at the middle aspect. The Hickman catheter was then placed over the guide wire into the superior vena cava. This was documented with fluoroscopy. A second incision was made 3 cm below the first distance of 2 cm transverse. The area between the two incisions was then tunneled with a curved six. The distal aspect of the catheter was brought out through the second inferior incision. The Teflon Hickman catheter was trimmed to the appropriate length with Teflon coating at the skin incision. The superior skin incision was closed with interrupted #30 nylon as was the inferior skin incision. The patient tolerated the procedure well. Code(s): Index entries:

Explanation / Answer

1.Look for the key word tunneling..Tt depends on the mechanism for implantation rather than the name of the catheter.The appropriate code for the procedure will be 36488 ie placementof a central venous catheter subclavian,jugular,or other vein for central venous pressure,hyperalimentation,haemodialysis or chemotherapy.

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