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1.            Tunneled Dialysis Catheter Placement                                  IDX CODE: UHIR01 - University: Interventional

PHYSICIANS:      

COMPLICATIONS:               None

CONTRAST:                         None

MEDICATIONS:          mg Versed IV;       mcg Fentanyl IV.
Conscious sedation was monitored by the Radiology Nursing Staff.

INDICATION:  Renal failure requiring hemodialysis.

PROCEDURE:  Using ultrasound guidance, the right/left internal jugular vein was punctured.  A 14 French 28 cm/32 cm AshSplit/Optiflow dual lumen hemodialysis catheter was inserted with its tip positioned at the caval atrial junction.  The catheter was placed through a subcutaneous tunnel requiring a second incision.  Chest radiograph at the completion of the procedure showed good catheter position.  The patient tolerated the procedure well.

Dr.                 was present.

IMPRESSION: Successful tunneled dialysis catheter placement as above.

                                                                                                                                                                                                                                               

2.            Tunneled Pheresis Catheter Placement                                 IDX CODE: UHIR02 – University: Interventional

PHYSICIANS:      

COMPLICATIONS:               None

CONTRAST:                         None

MEDICATIONS:          mg Versed IV;       mcg Fentanyl IV.
Conscious sedation was monitored by the Radiology Nursing Staff.

INDICATION:       

PROCEDURE:  Using ultrasound guidance, the right/left internal jugular vein was punctured.  A 13.5 French 36 cm/40 cm dual lumen pheresis catheter was inserted with its tip positioned at the caval atrial junction.  The catheter was placed through a subcutaneous tunnel requiring a second incision.  Chest radiograph at the completion of the procedure showed good catheter position.  The patient tolerated the procedure well.

Dr.                 was present.

IMPRESSION:  Successful tunneled pheresis catheter placement as above.

                                                                                                                                                                                                                                               

3.            Tunneled Hickman Catheter Placement                                 IDX CODE: UHIR03 - University: Interventional

PHYSICIANS:      

COMPLICATIONS:               None

CONTRAST:                         None

MEDICATIONS:          mg Versed IV;       mcg Fentanyl IV.
Conscious sedation was monitored by the Radiology Nursing Staff.

INDICATION:       

PROCEDURE:  Using ultrasound guidance, the right/left internal jugular vein was punctured.  A 10 French dual/9.6 French single lumen Hickman catheter was inserted with its tip positioned at the caval atrial junction.  The catheter was placed through a subcutaneous tunnel requiring a second incision.  Chest radiograph at the completion of the procedure showed good catheter position.  The patient tolerated the procedure well.

Dr.                 was present.

IMPRESSION:  Successful tunneled Hickman catheter placement as above.

                                                                                                                                                                                                                                               

4.            Central Line                                                                                   IDX CODE: UHIR04 - University:  Interventional

PHYSICIANS:      

COMPLICATIONS:               None

CONTRAST:                         None

MEDICATIONS:                    None

INDICATION:       

PROCEDURE:  Using ultrasound guidance, the right/left internal jugular vein was punctured and using this access a 7F triple lumen catheter was inserted with its tip positioned at the caval atrial junction.  Post placement radiograph showed good position.  The patient tolerated the procedure well.

Dr.                 was present.

IMPRESSION:  Successful triple lumen central venous catheter placement as above.

                                                                                                                                                                                                                                               

5.             Peripherally Inserted Central Catheter                                   IDX CODE: UHIR05 - University: Interventional

PHYSICIANS:      

COMPLICATIONS:               None

CONTRAST:                         None

MEDICATIONS:                    None

INDICATION:       

PROCEDURE:  Using ultrasound guidance, the right/left basilic/brachial/cephalic vein was punctured and using this access a   _ cm 4F single/5F dual lumen PICC was inserted with its tip positioned at the caval atrial junction.  Post placement radiograph showed good position.  The patient tolerated the procedure well.

Dr.                 was present.

IMPRESSION:  Successful PICC placement as above.

                                                                                                                                                                                                                                               

6.            Tunneled Catheter Removal                                                      IDX CODE: UHIR06 - University: Interventional

PHYSICIANS:      

COMPLICATIONS:               None

CONTRAST:                         None

MEDICATIONS:                    None

INDICATION:       

PROCEDURE:  After the administration of local anesthesia to the catheter exit site and dissecting the catheter cuff free, the catheter was removed, inspected, and confirmed to be removed in its entirety.  Hemostasis was achieved by manual compression.  The patient tolerated the procedure well.  (If the clinical indication is infection, add the following:  The tip was sent for culture.  If the cuff was retained, state this)

Dr.                 was present.

IMPRESSION:  Successful tunneled catheter removal as above.

                                                                                                                                                                                                                                               

7.            Tunneled Small Bore Central Catheter                                   IDX CODE: UHIR07 - University: Interventional

PHYSICIANS:      

COMPLICATIONS:               None

CONTRAST:                         None

MEDICATIONS:                    None

INDICATION:        (Note please include the specific indication for central rather than peripheral placement e.g. dialysis pt, transplant, elevated creatinine, etc.)

PROCEDURE:  Using ultrasound guidance, the right/left internal jugular vein was punctured.  A 5 French dual/4 French single lumen small bore central catheter was inserted with its tip positioned at the caval atrial junction.  The catheter was placed through a subcutaneous tunnel requiring a second incision.  Chest radiograph at the completion of the procedure showed good catheter position.  The patient tolerated the procedure well.

Dr.                 was present.

IMPRESSION:  Successful tunneled small bore central catheter placement as above.

                                                                                                                                                                                                                                               

8.             Nontunneled Dialysis/Pheresis Catheter                                IDX CODE: UHIR08 - University: Interventional

PHYSICIANS:      

COMPLICATIONS:               None

CONTRAST:                         None

MEDICATIONS:                    None

INDICATION:       

PROCEDURE:  Using ultrasound guidance, the right/left internal jugular vein was punctured and using this access a 13.5F 24 cm (Niagara) dual lumen nontunneled pheresis/dialysis catheter was inserted with its tip positioned at the caval atrial junction.  Post placement radiograph showed good position.  The patient tolerated the procedure well.

Dr.                 was present.

IMPRESSION:  Successful nontunneled pheresis/dialysis catheter placement as above.

                                                                                                                                                                                                                                               

9.            Ultrasound Guided Renal Biopsy                                              IDX CODE: UHIR09 - University: Interventional

PHYSICIANS:

COMPLICATIONS:               None

CONTRAST:                         None

MEDICATIONS:          mg Versed IV;       mcg Fentanyl IV.
Conscious sedation was monitored by the Radiology Nursing Staff.

INDICATION:       

PROCEDURE/FINDINGS: Using ultrasound guidance and 1% Lidocaine local anesthesia,       (number) core samples were obtained from the upper/lower pole of the right/left/transplant kidney with an 18-gauge core biopsy needle.  The samples were sent to surgical pathology for analysis.  The patient tolerated the procedure well, and was transferred to the floor in stable condition for post-procedure monitoring.

Dr.                 was present.

IMPRESSION: Successful ultrasound guided renal biopsy as above.

                                                                                                                                                                                                                                               

10.          Ultrasound Guided Liver Biopsy                                                IDX CODE: UHIR10 - University: Interventional

PHYSICIANS:      

COMPLICATIONS:               None

CONTRAST:                         None

MEDICATIONS:          mg Versed IV;       mcg Fentanyl IV.
Conscious sedation was monitored by the Radiology Nursing Staff.

INDICATION:       

PROCEDURE/FINDINGS: Using ultrasound guidance and 1 % Lidocaine local anesthesia,       (number) core samples were obtained from the right/left lobe of the liver with an 18-gauge core biopsy needle.  The samples were sent to surgical pathology for analysis.  The patient tolerated the procedure well, and was transferred to the floor in stable condition for post-procedure monitoring.

Dr.                 was present.

IMPRESSION: Successful ultrasound guided liver biopsy as above.

                                                                                                                                                                                                                                               

 

VIR Dictation Format

Your Name and Names of Physicians Involved
               
Indicate first & last names, and level (Staff, Fellow, Resident)

Patient Name and MRN

Referring Physician and Service

Procedure(s) Performed
                IVI cases
(Diagnosis & intervention of PVD, including MRA. Applies only to University Hospital and Wishard).  Must dictate This procedure was performed by physician members of the Indiana Vascular Institute

Clinical History
                This must provide justification for the procedure.

Complications

Contrast: type and amount used

Medications
               
List of drugs and doses
                Must dictate
Conscious sedation was monitored by Radiology Nursing Staff

Technique/Findings
                Must dictate
Dr. (attending name) was present

Summary (Impression)

Plan (if any)

For on call cases performed by the fellow without staff present, you:
                Must begin dictation with “This procedure was performed at no physician charge to the patient
                Must NOT dictate “Dr. (attending name) was present