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Pulse generator/Leads
OPERATION PERFORMED:
1. Extraction of right ventricular ICD lead.
2. Extraction of right atrial pace/sense lead.
3. Extraction of left ventricular pace/sense lead.
4. Extraction of biventricular ICD pulse generator.
ANESTHESIA:
Versed 2 and fentanyl 75.
PREOPERATIVE DIAGNOSIS:
Methicillin-sensitive Staph endocarditis.
POSTOPERATIVE DIAGNOSIS:
Methicillin-sensitive Staph endocarditis.
ESTIMATED BLOOD LOSS:
10.
CONTRAST:
Zero.
COMPLICATIONS:
None.
SPECIMENS TAKEN:
1. RV ICD lead tips sent for culture.
2. Right atrial lead tip sent for culture.
3. Left ventricular pace/sense lead sent for culture.
INDICATION FOR PROCEDURE:
Briefly, Mr. Javier Marquez is a 62-year-old gentleman, past medical history of
diabetes, hypertension, hyperlipidemia, ischemic cardiomyopathy, coronary
artery disease with prior stenting and Medtronic biventricular ICD implanted in
January 2018 for primary prevention strategy. He is admitted for
methicillin-sensitive Staph endocarditis. TEE suggestive of vegetation on the
ICD lead. He is seen and examined, deemed appropriate for extraction of ICD
PATIENT NAME: MARQUEZ,JAVIER IGNACIO ACCOUNT #: AD0227779103
leads as well as generator.
PROCEDURE AND FINDINGS:
The patient was brought to the EP lab in a postabsorptive state. Informed
consent was given by the patient prior to the procedure and confirmed.
Intravenous prophylactic antibiotics were administered prior to the procedure.
After the site of implantation was prepped and draped in the usual sterile
fashion, after adequate anesthesia was given, the skin was infiltrated with 1%
lidocaine and 1% bupivacaine mixture. The skin was incised with a plasma
blade. Blunt and electrosurgical dissection was carried out to the level of
the prepectoral fascia with careful attention paid to hemostasis. The pocket
housing the ICD pulse generator and leads was opened using blunt and
electrosurgical dissection. There was no evidence of pus within the ICD
pocket. The leads were disconnected from the pulse generator. Straight stylet
was advanced into the right atrial and right ventricular lead. The active
fixation mechanisms were retracted. With gentle traction and under
fluoroscopy, the RV ICD lead was removed. Subsequently, the right atrial pace
sense lead was then removed without difficulty. Lastly, the left ventricular
pace sense was extracted with gentle traction as well. The lead tips were
severed and sent for culture. The patient remained hemodynamically stable
throughout the procedure.
The pocket was copiously irrigated with antibiotic containing normal saline and
subsequently observed. The pocket was closed with multiple interrupted layers
of 2-0 Vicryl. It was then closed superficially with 1 layer of continuous
suture using 3-0 Vicryl, staples, Telfa, and Tegaderm.
Extracted Medtronic ICD pulse generator serial number RPE217496H.
Extracted right atrial lead Medtronic model 5076, serial number PJN4606738.
Extracted RV ICD lead Medtronic model 6935, serial number TDL230498V.
Extracted LV pace sense lead Medtronic model 4298, serial number QUA538209V.
CONCLUSION:
1. Successful extraction of Medtronic biventricular ICD.
2. There was no evidence of pus within the ICD pocket.
3. There were no obvious vegetations adherent to the leads at the time of
extraction.
4. All lead tips have been sent for culture.
5. He can be discharged home with a LifeVest and a new biventricular ICD can be
implanted on the right side following completion of IV antibiotic therapy for
endocarditis.
6. Follow up with me in clinic in 10 days for removal of staples.
Landon Medical LM-850 Accurate Pulse Rate Measurement
Measuring the pulse rate is one of the important steps in vital sign monitoring. The pulse rate gives so much insight to a person’s health that its measurement and making sure it is within normal parameters is of utmost importance. A pulse rate is commonly known as the arterial palpation of a heartbeat. Typically, a pulse can be felt in any place that allows for an artery to be compressed against a bone. In addition to the pulse rate as measured by beats per minute (BPM), the rhythm and strength of the heartbeat is an important indicator of heart and overall health. Changes in your heart rate or rhythm, a weak pulse, or a hard blood vessel may be caused by heart disease or another problem. Although many factors play into determining a normal pulse rate, for an adult a pulse rate in the range of 60 to 100 beats per minute (BPM) is considered healthy. However, there are athletes who have a healthy pulse rate below 60 BPM. Measuring the pulse rate is a key factor in maintaining a healthy body and conveys important information regarding the body’s state of health.
A great medical device to measure pulse rate is the Landon Medical’s LM-850 (FDA Approved) Digital Finger Pulse Oximeter measures SpO2 (percentage of oxygen saturation in the blood) and pulse rate with accuracy and ease. Specifically manufactured to be lightweight and portable the LM-850 model provides fast and accurate readings of blood oxygen saturation, pulse rate, Perfusion Index, and audio/visual alarm functions. Small and compact it provides complete oximetry solutions while still able to fit in your pocket.
The LM-850 Oximeter is a widely used medical device all health-care facilities, including hospitals, nursing homes, outpatient surgery centers, physician offices, dentist offices, emergency and ambulatory situations, sport athletes, as well for home diagnostics for monitoring such illnesses as COPD, cardiac problems, respiratory issues, asthma, and many more. The LM-850 model features an Organic Light Emitting Device (OLED) display and Plethsmograph capabilities.
www.PulseOximetersDirect.com is the trusted leader in providing the highest quality, lowest-cost, FDA approved pulse oximeters in the industry. Specializing in Finger Pulse Oximeter, Hand Held Pulse Oximeter, Pediatric Pulse Oximeter, or Sleep Apnea Unit Pulse Oximeter, POD’s oximeters provide physicians, healthcare professionals, and consumers accurate oximetry solutions for on-spot monitoring
Find More Medical Coding Articles
insertion or replacement of cranial neurostimulator pulse
1.) 61886 – insertion or replacement of cranial neurostimularor pulse with connection to 2 or more electrode arrays – Provider did bilateral – modifier 50 is not allowed unable to find any coding guidlines.
a.) coding – 61886 (LT)
61886 (RT)
or
61886 (LT)
61886 (59,RT)
2,) 61867 and 61868 – Humana paid 61867 but 61868 is done bilateral
a.) coding – 61868 (LT)
61868 (RT)
or
61868 (LT)
61868 (59,RT)
Any help would be great or any documentation regarding this.
thanks
Pulse Oximeter Goes To Medical School
Medical schools all over the United States strive to continue to provide the best education as possible to stay competitive for new students. Education comes in various forms ranging from actual educational material, to great professors, to hands on experience, and providing the latest and greatest tools to train future doctors. These medical tools or devices play a vital role in the development of future medical doctors. A quick analogy will explain this importance. When a person is first taught to drive, they are taught to use their mirrors to check all around them. Their mirrors are their tools or devices. If that student driver is taught with other means to check their surroundings, then that is how they are going to be molded to drive, even though it might be wrong technique. Medical students work in the same fashion. Whatever techniques and devices they are molded to use as they learn, will lead to what they use when they practice medicine.
A recent addition to the medical devices at medical schools all over the United States is a pulse oximeter. A pulse oximeter, also known as a pulse ox but some, is a medical device used to measure the blood oxygen saturation level and pulse rate of a patient. A finger pulse oximeter is now used by medical students to take on the spot measurements on patients. A pulse oximeter has proven to be a great tool due to its portability and accuracy. The traditional bulky oximeters are still used, but have shown to be very cumbersome. Medical students have truly adopted the oximeter. They have become so popular that many schools nationwide now require a pulse oximeter for every admitted student.
Our research has shown that PulseOximetersPlus.com is the pulse oximeter leader in the industry. They provide a wide range of products which start from $ 39, including free shipping.
For high quality, low-cost pulse oximeter models, visit us at http://www.PulseOximetersPlus.com.