Intrathecal pump catheter dye study

[Quito]

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Does anyone have a description on how to do an intrathecal pump catheter dye study or is it self-explanatory?

 

[painfree23]

The real answer is take the pump out

 

[Centurion38]

the rep should walk you through it. This is very straightforward..

 

[geauxg8rs]

The real answer is take the pump out

Or go back and time and smack yourself for dealing with pumps. The only pumps that cause me worry are the gas pumps

 

[lobelsteve]

Get the kit from medtronic.

Sterile prep and drape.

Access side port under fluoroscopy.
Withdrawal at least 1cc fluid to clear the catheter from pump to tip.
Inject Omnipaque 240 slowly and move the C-arm to follow contrast from pump to tip.
Check for leaks. Save lots of pics.

Reprogram pump to prime catheter so omni gets pushed out and meds get pushed to tip of catheter.

 

[Multimodal]

at least the new Medtronic systems also have a metallic ring at the distal tip of that catheter that should show up on fluoro. depending on your fluoroscope, the catheter can be a real pain to find. try finding the metal ring and following it back to the pump to make sure no kinks or contrast leak. When aspirating as Steve said above, make sure to draw back really slowly if you have an older (7+ yrs) catheter as some of those have a tendency to clog if too much negative pressure is applied.

I did some of these in training, then with the new group I joined 2 years ago, I cut pumps out of my practice other than for cancer pain. They are a huge PIA and I would estimate the vast majority of pump patients (opioid) are still on PO meds as well which leaves me to question what the heck the pump is doing in the first place for chronic pain.

 

[Ferrismonk]

Since the original question was answered, I'm going to go on a small tangent.

For those of you who still manage opioid pumps, what is your policy regarding UDS, opioid contracts, PDMP, other meds, etc? We have a few legacy pumps in the practice I joined, but rules for these patients are much more lax. Rarely do they get an office visit not attached to their pump refill. I've looked, but haven't seen any guidelines or recommendations for these patients. Curious what other people do.

 

[Ducttape]

when i do have pump patients, they have to be seen at least 3 months, UDS at least once a year. last noncancer pain patient is off all meds now, including those given intrathecal. last active pump patient was over a year ago.

an opioid is an opioid.

regardless of what KOLs say.

 

[deleted131481]

If you can't aspirate, be careful not to bolus the catheter unless you've calculated how much medicine is in there. It is possible to overdose the patient.

 

[Orin]

Agree with the above.

On the fluoro access, drop some lidocaine on the skin to be kind. You will want to get an en face view of the side port (Complications Associated with Intrathecal Drug Delivery Systems) which can mean obliquing to some weird angles.
Realize the pump is generally attached on an unstable muscle plane that moves with belly breathing, so keep the patient's relaxed or have them hold their breath at times.

The C-arm generally has a hard time with seeing the 24g Huber needle against the dense pump so drop another needle on the field so you can see exactly where you're poking.

When you think you're in the side port, get a shot across the pump and try to zoom in on the port as sometimes you aren't really in. You should be able to see your needle coming in with good fluoroscopy. I don't have a good online fluoro shot for that but imagine something in that right port.

That's only important if you can't aspirate, as if you get CSF, you know you're in.

You almost never want to inject if you can't aspirate.

Please remember to give a priming bolus after the study if you are able to get CSF as you don't want the patient to go into withdrawal. If you can't get CSF or it's not intrathecal, obviously not important.

The Ascenda catheter is easy to see once contrast is in it, and the tip does have a metal marker that you'll see on a lateral fluoroscopy easily but not as much in AP every time until you've done a few.

 

[BobBarker]

I think this procedure pays about $25. Lucky you.

 

[Orin]

I think this procedure pays about $25. Lucky you.

Reg billing: CPT 61070 for accessing a shunt/reservoir + 75809-26 for the shunt-o-gram + 62368 for the pump programming/bolus

 

[TIVAndy]

I think this procedure pays about $25. Lucky you.

shuntogram, fluoro, and reprogramming gives you about $100, about $200 if done in office

 

[TIVAndy]

Reg billing: CPT 61070 for accessing a shunt/reservoir + 75809-26 for the shunt-o-gram + 62368 for the pump programming/bolus

isn't it 76000? i always get conflicting info about this one.

 

[painfree23]

shuntogram, fluoro, and reprogramming gives you about $100, about $200 if done in office

I rather do bilat knee injection under fluoro

 

[Orin]

isn't it 76000? i always get conflicting info about this one.

My understanding from folks is:

76000 if you're doing a rotor study as you're doing the fluoro just for studying the pump device and are billing for the fluoroscopy time
75809 if you're doing a study for the catheter/reservoir flow/patency as it is a "shunt study"