Open vs. Percutaneous Approach

laura.rogers@franciscanalliance.org

We had an odd situation this week and could not find any guideline or clinic that covered it.

  A patient went to surgery because a previously stitched hole in a small intestine wall had opened up again.  They did an open approach to find the problem, then made a stab wound through the abdominal wall.  They threaded a Malecot drain through the stab incision, then inserted the tip of the drain into the intestine and secured it while working in the open surgical field.

What was the approach for the drain insertion? 

Thanks!

Laura

mgrn22

laura.rogers@franciscanalliance.org said:

We had an odd situation this week and could not find any guideline or clinic that covered it.

  A patient went to surgery because a previously stitched hole in a small intestine wall had opened up again.  They did an open approach to find the problem, then made a stab wound through the abdominal wall.  They threaded a Malecot drain through the stab incision, then inserted the tip of the drain into the intestine and secured it while working in the open surgical field.

What was the approach for the drain insertion? 

Thanks!

Laura

jmccorkl@stanfordhealthcare.org

I'd say it was Open approach.  They made a separate stab incision for the drain but manipulated it into position in the open surgical site.  
I must admit, I wouldn't have even thought to code the drain insertion separately!  For CDI purposes, I pretty much just get the main event.    

laura.rogers@franciscanalliance.org

It was an odd situation and the drain was the solution to the dehiscence of an intestinal wall wound.  All the other drain placements were JP drains that were part of the procedure. 

Thanks!