DOCSLIB.ORG

Bacteraemia After Manipulation of the Urinary Tract. the Importance of Pre

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Bacteraemia After Manipulation of the Urinary Tract. the Importance of Pre Postgrad Med J: first published as 10.1136/pgmj.54.636.668 on 1 October 1978. Downloaded from Postgraduate Medical Journal (October 1978) 54, 668-671 Bacteraemia after manipulation of the urinary tract. The importance of pre-existing urinary tract disease and compromised host defences RICHARD QUINTILIANI JOSEPH KLIMEK M.D. M.D. BURKE A. CUNHA EUFRONIO G. MADERAZO M.D. M.D. Division ofInfectious Diseases, Section ofHospital Epidemiology, Department ofMedicine and Medical Research Division, Hartford Hospital, Hartford, Connecticut 06115, U.S.A. Summary This surveillance system includes not only a tabu- The factors related to the occurrence of bacteraemia lation of all patients who have acquired a following urinary tract manipulation were studied in a bacteraemia, bacteriuria, wound infection or large community hospital. During a 3-year period, pulmonary infection, but also records the responsible forty-six of 326 episodes of hospital-acquired pathogen and the type of medical or surgical service bacteraemia were associated with urinary tract where the infection occurred. The criteria used for manipulation. All thirty of forty-six cases felt to be the determination of hospital-associated infections definitely related to urinary tract manipulation (other are those recommended by the Hospital InfectionsProtected by copyright. obvious sources of bacteraemia being absent) had Section of the Center for Disease Control, Atlanta, pre-existing urinary tract disease, especially of an Georgia (Bennett et al., 1971). obstructive type; only one in this group died from The charts of all patients with hospital-acquired sepsis. The remaining sixteen patients had other bacteraemias over a 3-year period (October 1970- possible sources of bacteraemia besides urinary tract October 1973) were reviewed for relevant clinical manipulation and had disorders associated with defects and epidemiological data to determine the number of in host defences; twelve (75%/) in this group died patients in whom the source for this infection was from overwhelming sepsis. Thus, if bacteraemia related to infection in the urinary tract. Figures in occurs in a patient having had urinary tract mani- the tables refer to the strains of organism recovered pulation but without any underlying urinary tract from a patient with a hospital-associated infection abnormality or impairment in host defences, its source due to this organism (i.e. one per patient per site). should be searched for in other areas of the body. If an organism was recovered from more than one site in the same patient, and if this organism was felt Introduction to be the cause of the hospital-associated infectionshttp://pmj.bmj.com/ Traditionally, most hospital epidemiology at those sites, it would count as more than one case. programmes have emphasized the distribution of Thus, one bacterium at two different sites in the infections but have paid considerably less attention same patient producing infection at each of these to the determinants. It is becoming increasingly clear sites would be considered as two cases. that the most important determinant in the acquisi- The bacteraemia was considered to be definitely tion of an infection in hospital is not the environ- related to instrumentation of the urinary tract only ment, but rather the adequacy of the host defence if the patient had no other obvious source for mechanisms of the patient. bacteraemia other than the urinary tract, and on September 25, 2021 by guest. This communication deals with the factors in cultures of urine and blood grew the same organism. patients in hospital that tend to make urinary tract A patient was felt to have significant bacteriuria if instrumentation a potentially lethal procedure, as a single midstream or catheter specimen of urine indicated by the development of bacteraemia. contained greater than 100 000 organisms/ml. Bladder instrumentation included any invasive Method procedure involving the urinary tract such as Since 1970 at Hartford (Connecticut) Hospital, an cystoscopy, single straight and indwelling bladder institution of about 950 beds, epidemiological data catherization, or recent operation on the urinary have been obtained on all patients who have tract. Since 1970, sterile, closed, indwelling bladder developed a hospital-associated infection, through catheter systems have been used, except in occasional the availability of two full-time nurse epidemio- circumstances where three-way catheters with logists and a computerized surveillance system. continuous antibiotic rinses have been employed. 0032-5473/78/1000-0668 $02.00 (© 1978 The Fellowship of Postgraduate Medicine Postgrad Med J: first published as 10.1136/pgmj.54.636.668 on 1 October 1978. Downloaded from Bacteraemia after manipulation of the urinary tract 669 TABLE 1. Major organisms associated with hospital-acquired bacteraemia, bacteriuria, and urinary tract (UT) instrumentation (October 1970-October 1973) - number of cases Bacteraemia definitely associated Organism Bacteriuria Bacteraemia with UT instrumentation Escherichia coli 1007 72 9 Proteus sp. 301 11 6 Klebsiella pneumoniae 243 29 4 Pseudomonas aeruginosa 296 31 1 Serratia marcescens 166 8 1 Enterococcus spp. 181 20 4 Enterobacter sp. 150 23 3 Citrobacter sp. 15 2 2 Other bacteria 242 130 0 Total 2601 326 30 During the period of this study, 'open' non-sterile definitely associated with the instrumentation of the bladder drainage tubes have been prohibited. During urinary tract unless there was some type of under- the 3-year period of the study there were 29 859 lying urinary tract disease. indwelling bladder catheters dispensed from the Table 3 records both the type of urinary tract Central Supply Department, and 27375 blood disease and the kind of instrumentation employed cultures were processed by the Microbiology in these bacteraemiic patients. It is apparent from this Laboratory. Serotyping of the organisms was not chart that the majority of patients not only had performed. obstructive uropathy - usually produced by prostatic disease or calculi - but also underwent more than Protected by copyright. Results one type of instrumentation. In fact, eighteen The incidence of bacteriuria induced by urinary patients had all three types of instrumentation, tract instrumentation and the number of cases of namely indwelling bladder catheterization, cysto- bacteraemia from all types of hospital-acquired scopy, and operation of the urinary tract. Of the infection are shown in Table 1. Over the period remaining twelve cases, two had both cystoscopy reviewed, there was an average of 867 patients per and indwelling bladder catheterization, and ten year with hospital-acquired bacteriuria or an patients had insertion of a bladder catheter alone. accumulative total of 2601 cases over the 3-year In this group of thirty patients, one patient died period; during the same time, there were 326 from septic shock; this case had obstructive uro- episodes of bacteraemia. However, in only thirty pathy secondary to cancer of the bladder. patients (8%y) was it felt to be definitely related to the The predominant organism recovered from the urinary tract instrumentation. blood in these 30 patients was Escherichia coli (9). It was followed in decreasing frequency by Proteus TABLE 2. Associated conditions in patients with bacter- sp. (6), Enterococcus (4), Klebsiella pneumoniae http://pmj.bmj.com/ aemia definitely related to urinary tract (UT) instrumentation (4), Enterobacter sp. (3), Citrobacter freundii Condition No. cases (2) and one case each of Pseudomonas aeruginosa and Serratia marcescens. Pre-existing UT disease alone 23 Pre-existing UT disease and diabetes 4 Discussion Pre-existing UT disease and cirrhosis 2 Instrumentation of the urinary track has always Pre-existing UT disease, diabetes mellitus, I cirrhosis been a subject ofconsiderable controversy. Although No pre-existing UT disease 0 this procedure has been known for some time to be on September 25, 2021 by guest. a greater risk in patients with pre-existing renal Total 30 disease or compromised host defences, quantitation of the actual danger is still unavailable in different Table 2 records the associated conditions in the types of patients in hospital. The present surveillance thirty patients in whom the bacteraemia was data help to fill some of this gap in knowledge definitely related to urinary tract instrumentation. regarding the relative hazard of urinary tract All these patients had pre-existing urinary tract instrumentation in a diverse group of patients in a disease. In seven patients with underlying urinary large community hospital. tract disease, there were additional associated The present study indicates that urinary tract illnesses that could further compromise host defences instrumentation is frequently associated with such as diabetes mellitus and Laennec's cirrhosis. bacteriuria in all types of patient but is not a Importantly, in no patient was the bacteraemia common cause of sustained bacteraemia, except for Postgrad Med J: first published as 10.1136/pgmj.54.636.668 on 1 October 1978. Downloaded from 670 R. Quintiliani et al. TABLE 3. Pre-existing urinary tract disease in patients with bacteraemia definitely related to instrumentation of the urinary tract Type of instrumentation No. of Indwelling bladder Operation Urinary tract disease patients catheter Cystoscopy urinary tract Calculus ureter 5 5 5 5 Obstructive uropathy 20 BPH 5 5 1 - Postoperative TUR for BPH 5 5 5 5 Bilateral pyelonephritis 3 3 - - Obstructive uropathy 2'CA bladder
Load more

Recommended publications
  • A Clever Technique for Placement of a Urinary Catheter Over a Wire
    [Downloaded free from http://www.urologyannals.com on Monday, August 24, 2015, IP: 107.133.192.199] Original Article A clever technique for placement of a urinary catheter over a wire Joel E. Abbott, Adam Heinemann, Robert Badalament, Julio G. Davalos1 Department of Urology, St. John Providence, Michigan State University, Detroit, MI 48071, 1Chesapeake Urology Associates, University of Maryland, Baltimore, MD 21061, USA Abstract Objective: The objective was to present a straightforward, step-by-step reproducible technique for placement of a guide-wire into any type of urethral catheter, thereby offering a means of access similar to that of a council-tip in a situation that may require a different type of catheter guided over a wire. Materials and Methods: Using a shielded intravenous catheter inserted into the eyelet of a urinary catheter and through the distal tip, a “counsel-tip” can be created in any size or type of catheter. Once transurethral bladder access has been achieved with a hydrophilic guide-wire, this technique will allow unrestricted use of catheters placed over a wire facilitating guided catheterization. Results: Urethral catheters of different types and sizes are easily advanced into the bladder with wire-guidance; catheterization is improved in the setting of difficult urethral catheterization (DUC). Cost analysis demonstrates benefit overuse of traditional council-tip catheter. Conclusion: Placing urinary catheters over a wire is standard practice for urologists, however, use of this technique gives the freedom of performing wire-guided catheterization in more situations than a council-tip allows. This technique facilitates successful transurethral catheterization over wire in the setting of DUC for all catheter types and styles aiding in urologic management of patients at a cost benefit to the health care system.
    [Show full text]
  • CMS Manual System Human Services (DHHS) Pub
    Department of Health & CMS Manual System Human Services (DHHS) Pub. 100-07 State Operations Centers for Medicare & Provider Certification Medicaid Services (CMS) Transmittal 8 Date: JUNE 28, 2005 NOTE: Transmittal 7, of the State Operations Manual, Pub. 100-07 dated June 27, 2005, has been rescinded and replaced with Transmittal 8, dated June 28, 2005. The word “wound” was misspelled in the Interpretive Guidance section. All other material in this instruction remains the same. SUBJECT: Revision of Appendix PP – Section 483.25(d) – Urinary Incontinence, Tags F315 and F316 I. SUMMARY OF CHANGES: Current Guidance to Surveyors is entirely replaced by the attached revision. The two tags are being combined as one, which will become F315. Tag F316 will be deleted. The regulatory text for both tags will be combined, followed by this revised guidance. NEW/REVISED MATERIAL - EFFECTIVE DATE*: June 28, 2005 IMPLEMENTATION DATE: June 28, 2005 Disclaimer for manual changes only: The revision date and transmittal number apply to the red italicized material only. Any other material was previously published and remains unchanged. However, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents. II. CHANGES IN MANUAL INSTRUCTIONS: (N/A if manual not updated.) (R = REVISED, N = NEW, D = DELETED) – (Only One Per Row.) R/N/D CHAPTER/SECTION/SUBSECTION/TITLE R Appendix PP/Tag F315/Guidance to Surveyors – Urinary Incontinence D Appendix PP/Tag F316/Urinary Incontinence III. FUNDING: Medicare contractors shall implement these instructions within their current operating budgets. IV. ATTACHMENTS: Business Requirements x Manual Instruction Confidential Requirements One-Time Notification Recurring Update Notification *Unless otherwise specified, the effective date is the date of service.
    [Show full text]
  • Interventional Radiology and Interventional Endoscopy Practical Applications for Veterinary Medicine
    Interventional Radiology and Interventional Endoscopy Practical Applications for Veterinary Medicine Megan Morgan, VMD, DACVIM Marnin Forman, DVM, DACVIM This lecture is sponsored by… Outline – Background on Interventional Radiology (IR) and Interventional Endoscopy (IE) – IR and IE in the treatment of Urolithiasis – IR and IE in the treatment of Urinary incontinence – IR and IE in the treatment of Tracheal collapse – IR and IE in the treatment of Urinary obstructions IR and IE-Background • What is Interventional Radiology (IR)? – A specialty that utilizes image guidance to perform minimally invasive procedures to diagnose and treat disease. Thoracic radiograph of a patient with a tracheal stent 4 IR and IE-Background • What is Interventional Endoscopy (IE)? – A specialty that utilizes endoscopic guidance to perform minimally invasive procedures to diagnose and treat disease. Cystoscopic image of a patient with bilateral ectopic ureters 5 IR and IE-Background • Image guidance tools - Fluoroscopy - Ultrasound - Digital radiography - CTA - MRA Seldinger Technique • Minimally invasive access http://www.accessmedicine.ca - Natural orifice - Seldinger technique 6 IR and IE-Background • IR and IE goals – Palliation of clinical signs – Adjuvant therapy – Definitive treatment Fluoroscopic image of a retrograde contrast urethrocystogram in a patient with urethral transitional cell carcinoma 7 IR and IE-Background . IR and IE equipment – Guidewires • Most common sizes –0.035 inch--fits through an 18 gauge needle –0.018 inch--fits through a 22 gauge needle –0.025 inch--fits through a 20 gauge needle – Specialized catheters • Categorized by the type of tip Vascular access catheters IR and IE-Background . IR and IE equipment – Sheaths • Sized by the size of the catheter accepted by the sheath • The actual diameter of the sheath is larger than the listed sheath size Vascular access sheath – Stents • Multiple material types • Wire mesh vs.
    [Show full text]
  • Preventing Catheter Associated Urinary Tract Infections (CAUTI): What You Need to Know About Urinary Catheterization
    Preventing Catheter Associated Urinary Tract Infections (CAUTI): What You Need to Know About Urinary Catheterization Presented by Mary W. Sears, RN, BA, CWOCN with Capital Nursing Education Objectives • List two (2) advantages of intermittent catheterization over indwelling catheterization • List two (2) specific clinical conditions that are considered acceptable for the placement of an indwelling urinary catheter Capital Nursing Education ©2015. All rights reserved. WOCN Best Practices Can be ordered from WOCN Bookstore @ wocn.org Capital Nursing Education ©2015. All rights reserved. Urinary Catheterization Should only be undertaken when all other methods of urinary system management have been deemed inappropriate or have failed. Short or long-tem usage-depends on cause of urinary dysfunction (Newman-2008) • Indwelling • Intermittent – Urethral – Suprapubic Capital Nursing Education ©2015. All rights reserved. Suprapubic Catheterization • Definition: • Inserted surgically through the anterior abdominal wall 2 cm above pubic bone into the bladder • Allows for continuous drainage • Indications: – Short term use following surgery – Alternative to chronic indwelling catheter – Option for long-term catheterization – To avoid urethral damage in men Capital Nursing Education ©2015. All rights reserved. Suprapubic Catheters • Advantages: – Decreases risk of contamination from organisms from fecal material – Decreases risk of infection due to less antimicrobial content on abdomen vs perineum • Potential problems: – Urine leakage – Skin erosion – Hematoma – Catheter reinsertion difficulty Capital Nursing Education ©2015. All rights reserved. Suprapubic Catheter Insertion/Reinsertion • Initial insertion by physician or specially trained urology specialist • New suprapubic tract takes 10 days to 4 weeks to become established • Reinsertion by appropriately trained health care professional when tract is well established • Interval can range from 2 to 10 weeks WOCN Best Practice (2009) Capital Nursing Education ©2015.
    [Show full text]
  • Female Urethral Catheterization
    T h e new england journal o f medicine videos in clinical medicine Female Urethral Catheterization Rafael Ortega, M.D., Linda Ng, M.D., Pavan Sekhar, B.S., and Michael Song, M.A. Introduction Female urethral catheterization, the insertion of a catheter through the urethra into From the Departments of Anesthesiology the urinary bladder to permit drainage of urine, is a fundamental skill for the prac- and Urology, Boston University Medical Center, Boston. Address reprint requests ticing health care professional. to Dr. Ortega at the Department of Anes- thesiology, Boston University Medical Center, 88 E. Newton St., Boston, MA Indications 02118, or at [email protected]. Female urethral catheterization is indicated for both therapeutic and diagnostic pur- N Engl J Med 2008;358:e15. poses. It permits effective bladder drainage in patients with acute or chronic urinary Copyright © 2008 Massachusetts Medical Society. retention. A urinary catheter may be used to instill medication for local intravesical therapy or for irrigation to remove blood and clots from the urinary bladder. Urethral catheterization facilitates diagnosis in several circumstances, such as ob- taining sterile urine specimens for urinalysis, measuring residual volumes after void- ing, instilling contrast media for imaging procedures, and monitoring the urinary output of critically ill patients.1 Contraindications Urethral injury can be a contraindication to catheterization. Urethral injuries are rare and most commonly result from pelvic fractures. If blood is found at the urethral meatus, urethral or bladder neck injury should be considered. If there is any ques- tion of injury, genital and rectal exams should be performed and retrograde urethrog- raphy should be considered before catheterization is attempted; consultation with a specialist before catheterization is prudent.
    [Show full text]
  • Self-Catheterization of Urinary Bladder Complicated with Extraperitoneal Abscess That Mimics an Infected Bladder Diverticulum
    Urological Science 25 (2014) 137e138 Contents lists available at ScienceDirect Urological Science journal homepage: www.urol-sci.com Case report Self-catheterization of urinary bladder complicated with extraperitoneal abscess that mimics an infected bladder diverticulum Yu-Cing Juho, Seng-Tang Wu, En Meng, Chih-Wei Tsao, Tai-Lung Cha, Dah-Shyong Yu, * Guang-Huan Sun, Cheng-Ping Ma, Sun-Yran Chang, Shou-Hung Tang Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC article info abstract Article history: For patients who are suffering from neurogenic lower urinary tract dysfunction, intermittent urinary Received 4 April 2014 catheterization is an efficient way to empty the bladder.1 However, the method may result in various Received in revised form complications. Herein we present a rare complication of extraperitoneal abscess owing to intermittent 17 August 2014 urinary catheterization in a 62-year-old male who had cervical spine injury and was treated with Accepted 18 August 2014 intermittent urethral catheterization for neurogenic lower urinary tract dysfunction. Treatment and a Available online 28 October 2014 literature review are also described. Copyright © 2014, Taiwan Urological Association. Published by Elsevier Taiwan LLC. Keywords: bladder perforation Open access under CC BY-NC-ND license. extraperitoneal abscess intermittent urinary catheterization neurogenic bladder 1. Introduction Repeated urinary tract infections were noted a few times each year after the patient started to receive CIC. It was only a few days Clean intermittent self-catheterization (CIC) of the urinary before coming to our hospital that he began experiencing low- bladder, proposed by Dr Lapedes in early 1972, is accepted as the grade fever as well as a markedly poor appetite.
    [Show full text]
  • Original Article Influence of Bladder Management on Epididymo-Orchitis
    Spinal Cord (2006) 44, 165–169 & 2006 International Spinal Cord Society All rights reserved 1362-4393/06 $30.00 www.nature.com/sc Original Article Influence of bladder management on epididymo-orchitis in patients with spinal cord injury: clean intermittent catheterization is a risk factor for epididymo-orchitis JH Ku1, TY Jung1, JK Lee1, WH Park2 and HB Shim*,1 1Department of Urology, Seoul Veterans Hospital, Seoul, Republic of Korea; 2Department of Urology, College of Medicine, Inha University, Seoul, Republic of Korea Study design: Retrospective study, based on cases of spinal cord injury (SCI). Objectives: To establish hazard ratios for risk of epididymo-orchitis in SCI. Setting: South Korea. Methods: A total of 140 male patients injured before 1987 were eligible for this investigation and have been followed up on a yearly basis from January 1987 to December 2003. Results: The average age at which the lesion occurred was 24.8 years old (range, 18–53). The average time since SCI was 16.9 years (range, 1–37). A total of 34 lesions (24.3%) were complete and 106 (75.7%) were incomplete. Over the 17 years, 39 patients (27.9%) were diagnosed with epididymo-orchitis. Epididymo-orchitis was more common for patients with a history of urethral stricture (66.7 versus 25.2%, P ¼ 0.014). We also found that epididymo-orchitis was more common for patients on clean intermittent catheterization (CIC) than with indwelling urethral catheterization (42.2% versus 8.3%, P ¼ 0.030). In multivariate analysis, patients on CIC had a 7.0-fold higher risk (odds ratio, 6.96; 95% confidence interval, 1.26–38.53; P ¼ 0.026); however, a history of urethral stricture lost statistical significance (P ¼ 0.074).
    [Show full text]
  • Methods and Types of Urinary Catheters Used for Indwelling Or Intermittent Catheterization
    TEACHING TOOL Methods and Types of Urinary Catheters Used for Indwelling or Intermittent Catheterization Diane K. Newman, DNP, ANP-BC, FAAN, BCB-PMD Figure 1. © 2021 Society of Urologic Nurses and Associates Color-Coded Catheter Size Chart Newman, D.K. (2021). Methods and types of urinary catheters used for indwelling or intermittent catheteriza- tion. Urologic Nursing, 41(2), 111-117. https://doi.org/ 10.7257/1053-816X.2021.41.2.111 There are various urinary catheterization techniques, and unfortunately, it is not always clear what is exactly meant by a certain technique that is mentioned in the lit- erature (Vahr et al., 2013). This Teaching Tool provides descriptive information on urinary catheterization meth- ods, characteristics of catheter type, and material, specific uses (indwelling urinary catheter, intermittent catheteri- zation), and considerations. Catheter Characteristics Urinary catheters can be divided into two categories: indwelling (referred to as indwelling urinary catheters [IUCs] or Foley catheters) or inserted as a single catheteri- zation (referred to as “straight” or “in-and-out,” or inter- mittent catheterization [IC]) (Newman, 2017; Newman et al., 2018). This section outlines the most commonly used catheters for IUCs and IC. Urinary catheters come in varying sizes, configura- tions and material. There is insufficient evidence to deter- Source: Courtesy of Robin Noel. mine whether there is an optimal catheter type for those requiring either short-term (Lam et al., 2014) or long-term Catheter size: The accepted measurement unit for bladder drainage (Jahn et al., 2012). catheters is the French catheter scale, French gauge (Fr or Catheter lumen: The main differences between an F) or Charriere (Ch), based on the cross-sectional diameter IUC and a catheter used for straight catheterization or IC of the catheter in millimeters (Newman et al., 2018).
    [Show full text]
  • Guidelines for the Prevention of Catheter- Associated Urinary Tract Infection Published on Behalf of SARI by HSE Health Protection Surveillance Centre 2011
    Guidelines for the Prevention of Catheter- associated Urinary Tract Infection Published on behalf of SARI by HSE Health Protection Surveillance Centre 2011 Health Protection Surveillance Centre 25-27 Middle Gardiner Street Dublin 1 Ireland Tel +353 1 876 5300 Fax +353 1 856 1299 Email [email protected] www.hpsc.ie SARI This report is also available to download on the HPSC website at www.hpsc.ie A Strategy for the Control of Antimicrobial Resistance in Ireland SARI Guidelines for the Prevention of Catheter- associated Urinary Tract Infection Published on behalf of SARI by HSE Health Protection Surveillance Centre 2011 ISBN 978-0-9551236-9-6 Guidelines for the Prevention of Catheter-associated Urinary Tract Infection HSE/HPSC Contents Background 1 Terms of Reference 1 Foreword 2 Section 1: Summary of Recommendations 3 Section 2: Rationale for Recommendations 1.0 Introduction 6 1.1 Background 6 1.2 Definition of catheter-associated urinary tract infection (CAUTI) 6 1.3 Pathogenesis 6 1.4 Risk factors for CAUTI 7 1.5 Morbidity and mortality associated with CAUTI 7 2.0 Factors to consider before catheterisation 7 2.1 Avoid catheterisation 7 2.2 Indications for catheterisation 7 2.3 Method of catheterisation 8 2.4 Selection of a urinary catheter 9 2.4.1 Introduction 9 2.4.2 Catheter size 9 2.4.3 Catheter material 9 3.0 Insertion of a urinary catheter 10 3.1 Standard precautions 10 3.2 Aseptic technique 10 3.3 Hand decontamination 10 3.4 Personal protective equipment 11 3.5 Patient preparation 11 3.6 Meatal cleaning and disinfection 11 3.6.1 Prior
    [Show full text]
  • A Quarterly Publication of the Central Office on ICD-9-CM Volume 31 First Quarter Number 1 2014
    A quarterly publication of the Central Office on ICD-9-CM Volume 31 First Quarter Number 1 2014 In this issue Farewell Coding Clinic for ICD-9-CM 3 Ask the Editor Atypical Meningioma 16 Complicated Bereavement 10 Electrical Status Epilepticus of Sleep 11 Extracardiac Fontan Procedure 9 Fluctuations in Body Mass Index (BMI) 17 Heart Failure and Preserved or Reduced Ejection Fraction (HFpEF/HFrEF) 6 Heat Ablation of Saphenous Vein 6 Hemi-Fontan Procedure with Pulmonary Artery Augmenation 15 Immune Thrombocytopenic Purpura and Pancytopenia 7 Infected Total Knee Replacement due to Corynebacterium Diphtheriae 5 LINX Reflux Management System 7 Malone Antegrade Continence Enema (MACE) Procedure 15 MOST Prosthetic Total Femoral Replacement 12 Multifocal Motor Neuropathy 10 Neuroendocrine Small Cell Carcinoma of the Cervix 5 Nonconvulsive Status Epilepticus 12 Previable Newborn 16 Progressive Familial Intrahepatic Cholestasis Type II 8 Renal Denervation 8 Retained Laparotomy Sponge during Cesarean Delivery 14 Splenosis 11 Traumatic Urinary Catheterization 12 Clarification Bacteremia Due to PICC Line 18 Preterm Premature Rupture of Membranes and Preterm Delivery 19 Correction Dissection of Internal Carotid Artery 20 Methicillin Resistant Staphylococcus Aureus (MRSA) Sepsis 20 Notice Update––Foreign Body Left During Surgery 21 Coding Clinic First Quarter 2014 1 Coding advice or code assignments contained in this issue effective with discharges March 31, 2014. Coding Clinic Gretchen Young-Charles, Robert Haralson, M.D. for ICD•10•CM/PCS RHIA, Senior Coding Representative for Consultant, Central Office American Medical Published quarterly by the on ICD-10-CM/PCS Association, Walland, TN American Hospital Association Halima Zayyad-Matarieh, Erika Hardy, RHIA, CCS, Central Office on ICD-10-CM/PCS RHIA, Coding Consultant, CDIP, Assistant Director of 155 N.
    [Show full text]
  • APG Regulations
    FINAL as of 8/22/08 Pursuant to the authority vested in the Commissioner of Health by Section 2807(2-a) of the Public Health Law, Part 86 of Title 10 of the Official Compilation of Codes, Rules and Regulations of the State of New York, is amended by adding a new Subpart 86-8, to be effective upon filing with the Secretary of State, to read as follows: SUBPART 86-8 OUTPATIENT SERVICES: AMBULATORY PATIENT GROUP (Statutory authority: Public Health Law § 2807(2-a)(e)) Sec. 86-8.1 Scope 86-8.2 Definitions 86-8.3 Record keeping, reports and audits 86-8.4 Capital reimbursement 86-8.5 Administrative rate appeals 86-8.6 Rates for new facilities during the transition period 86-8.7 APGs and relative weights 86-8.8 Base rates 86-8.9 Diagnostic coding and rate computation 86-8.10 Exclusions from payment 86-8.11 System updating 86-8.12 Payments for extended hours of operation § 86-8.1 Scope (a) This Subpart shall govern Medicaid rates of payments for ambulatory care services provided in the following categories of facilities for the following periods: (1) outpatient services provided by general hospitals on and after December 1, 2008; (2) emergency department services provided by general hospitals on and after January 1, 2009; (3) ambulatory surgery services provided by general hospitals on and after December 1, 2008; (4) ambulatory services provided by diagnostic and treatment centers on and after March 1, 2009; and (5) ambulatory surgery services provided by free-standing ambulatory surgery centers on and after March 1, 2009.
    [Show full text]
  • Clinical, Radiographic and Pathological Features of Urinary
    V CLINICAL, RADIOGRAPHIC AND PATHOLOGICAL FEATURES OF URINARY CONDITIONS IN DOGS IN NAIROBI, KENYA A THESIS SUBMITTED IN PARTIAL FULFILMENT OF REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN CLINICAL STUDIES DR. SHARON ANDEYO TSIGADI, BVM (UNIVERSITY OF NAIROBI) DEPARTMENT OF CLINICAL STUDIES FACULTY OF VETERINARY MEDICINE UNIVERSITY OF NAIROBI University of NAIROBI Library 2012 > 11 DECLARATION This thesis is my original work and has not been presented for a degree in any other University. SIGNED DR SHARON ANDETO TSIGADI DATE: MATEO 2J0I2. This thesis has been submitted for examination with our approval as University Supervisors; SIGNED PROF. SUSAN W. MBUGUA. BVM, MSc, PhD DATE: & * ^ -P \ ‘\L SIGNED PROF PETER K. GATHUMBI, BVM, MSc, PhD DATE: ijf^ A\ q \ x L U ? ) i _ SIGNED DR. JOHN DEMESI MANDE, BVM, MSc, PhD DATE: /3 -os-xoio. Ill DEDICATION This work is dedicated to my parents Mr. and Mrs. Solomon Tsigadi and to Stephen for their encouragement and unwavering support. > iv ACKNOWLEDGEMENTS This study was completed with the financial support of the University of Nairobi which awarded me a full scholarship. I would like to acknowledge the material support and use of facilities and equipment in the Department of Clinical Studies and the Department of Pathology, Microbiology and Parasitology that enabled me carry out this research. The critical and constructive input of my supervisors Professor Susan W. Mbugua, Professor Peter K. Gathumbi and Dr. John D. Mande is highly appreciated. My sincere thanks also go to the radiographer at the Department of Clinical Studies, Mr. Gilbert Ogola, and the staff at the Small Animal Clinic; Mr.
    [Show full text]