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Date: Aug 25, 2010

Question:

I know this is simple, but i've gotten varying answers on this one...75984/47525...also add the 74305/47505?? thanks 1) CHOLANGIOGRAM THROUGH EXISTING TUBE 2) BILIARY TUBE CHANGE 3) SEDATION History: 60-year-old woman with left biliary drainage tube. She has had a Whipple procedure and had an anastomotic stricture at the H-J as well as a right-sided abdominal fistula. The fistula has since sealed. She is due for routine tube change. Indications: For biliary tube change. Medications: 2 mg of Versed and 100 mcg of Fentanyl were given IV for complex conscious sedation. Unasyn 3 grams was given IV. Contrast: 10 cc of Omnipaque 350 Complications: None Technique: After informed consent was obtained and confirmation of patient identification and the planned procedure was carried out, the patient's upper abdomen including the single left biliary tube was prepped and draped in the usual fashion. Contrast was instilled via the tube and cholangiography thereby performed. Local anesthesia was instilled around the drain exit site. A Glidewire was passed through the tube. It was advanced into the small bowel. The tube was removed over the wire. A new 18 French Heyer-Schulte catheter was passed over the wire and positioned appropriately just inside the entered left duct. The wire was removed. Contrast was instilled to confirm positioning. The catheter was then secured with 2-0 Nylon sutures. The catheter was capped. A small amount of granulation tissue was treated with silver nitrate. Sterile dressings were applied. Findings: The cholangiogram demonstrates nondilated biliary ducts. The tube was appropriately within the ductal system. Contrast flows freely to the small bowel. Postop changes are again noted. There is no extravasation. An uneventful tube change was carried out. Impression: Successful left biliary tube change. Recommendations: The patient will return to CVIR in eight weeks for her next routine tube change

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