Postoperative Diagnosis: Malignant recurrent pleural effusions
Procedure(s): PleurX catheter placement
Indications for Procedure: This is a 75 year old female with metastatic lung adenocarcinoma with recurrent malignant pleural effusions. Given patient has required multiple thoracentesis and has symptomatically improved with each one. She was deemed a candidate for PleurX catheter.
Estimated Blood Loss: None
Procedure Details:
Informed consent was obtained and the patient was taken to the operating room and positioned supine on the OR table with all pressure points padded. She was placed under sedation by anesthesia. An ultrasound was used to evaluate the right pleural space and select an appropriate position for the tube. She was then prepped and draped in sterile fashion and a time-out was performed.
Local anesthesia with %1 Lidocaine was used to numb the skin. The finder needle was then used to access the right pleural space. Aspiration revealed serosanguinous pleural fluid. A wire was advanced without difficulty. A separate stab incision was made anteriorly along the patient’s chest wall and the PleurX cathter was tunneled through the subcutaneous tissue. A peel-away sheath and dilator were advanced over the wire in standard Seldinger fashion and the catheter was inserted through the sheath without difficulty. The cathter was secured to the skin with a Nylon suture and the incisions closed with 4-0 monocryl followed by dermabond. The cathter was hooked up to suction with a total of ~550cc drained. The cap was then placed over the catheter and a sterile dressing applied. All counts were correct at the end of the case. The patient tolerated the procedure well. She was awaked from anesthesia and taken to PACU in stable condition.
CPT code : 32550 Insertion of indwelling tunneled pleural catheter with cuff
ICD-10 :C34.90 Malignant neoplasm of unspecified part of unspecified bronchus or lung
J91.0 Malignant pleural effusion