OPERATIVE REPORT PERMANENT PACEMAKER INSERTION

question 26

Short Answer

OPERATIVE REPORT
PERMANENT PACEMAKER INSERTION
PROCEDURE PERFORMED: Permanent pacemaker insertion.
INDICATION: Symptomatic bradycardia.
DESCRIPTION OF THE PROCEDURE: Informed consent was obtained. The patient was pre-medicated with intravenous Versed and Nubain. The left infraclavicular area was prepped and draped in the usual manner. The area was then anesthetized with 1% Lidocaine. The left subclavian vein was entered with an 18-gauge thin-walled needle. A guidewire was advanced through the needle. The needle was removed. A 1.5-inch incision was made down to the pectoralis fascia. Using blunt and sharp dissection a pocket was created. A 9-French sheath introducer set was advanced over the guidewire and the introducer was removed. A Medtronic ventricular lead was advanced to the right ventricle. In the final position, the measured R wave was 7.9 mV. The captured threshold was 0.7 volt and the lead impedance was 860 ohms. A 7-French sheath introducer set was advanced over the wire and the wire and the introducer were removed. A Medtronic atrial lead was advanced to the right atrium and in the final position the measured P wave was 6.2 mV. The captured threshold was 0.4 volt and the lead impedance was 639 ohms.
Both leads were anchored in place using 0 silk that was sutured around the anchor and its lead. Both leads were then connected to a Medtronic pulse generator brand name Kappa DR, model #KDR901. The pulse generator and the leads were positioned inside the pocket after it was flushed with Neomycin. The subcutaneous tissue was closed with 3-0 Vicryl and the skin was closed with 4-0 Vicryl. The patient tolerated the procedure well and there were no complications. The device was programmed to DDDR, lower rate of 60, upper rate of 130.
CPT Code: ____________________

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Definitions:

Allelic Form

Allelic form refers to the variant form of a gene that arises by mutation and is found at the same place on a chromosome as other alleles of the gene, leading to genetic diversity within a population.

Ontogenetic

Pertaining to the development of an individual organism or individual anatomical or behavioral characteristic from conception to maturity.

Monozygotic

Referring to twins developed from a single fertilized ovum, hence they are genetically identical.

Codominant

A genetic scenario in which two alleles of a gene are expressed equally in the phenotype of heterozygotes.