CPT® Code 93561

Deleted

1. Indications

Indicator dilution studies with cardiac output measurement are indicated for the evaluation of various cardiovascular conditions. The following are the primary indications for performing this procedure:

• Intracardiac Shunts - These studies help in identifying abnormal blood flow between heart chambers, which can lead to significant clinical implications.
• Valvular Regurgitation - The procedure is utilized to assess the severity of backward blood flow through heart valves, which can affect overall cardiac function.
• Assessment of Cardiac Function - Cardiac output measurement is crucial for evaluating the heart's pumping efficiency, particularly in patients with heart failure or other cardiac conditions.

2. Procedure

The procedure for indicator dilution studies with cardiac output measurement involves several critical steps, which are detailed below:

• Step 1: Catheter Insertion - For dye dilution studies, both venous and arterial catheters are inserted. In the case of thermal dilution, a Swan-Ganz catheter is introduced through the internal jugular or subclavian vein, advanced into the right atrium and ventricle, and positioned in a branch of the pulmonary artery.
• Step 2: Calibration of the Densitometer - In dye studies, a blood sample is obtained, and the densitometer is calibrated using known concentrations of the dye mixed with the patient's blood sample to ensure accurate measurements.
• Step 3: Dye Injection - For dye dilution, the contrast dye is injected into the catheterized vein. The dye mixes with the blood, circulates through the heart, and is subsequently pumped into the arteries.
• Step 4: Blood Sample Collection - A blood sample is drawn from the catheterized artery to analyze the concentration of the dye present in the bloodstream.
• Step 5: Analysis of Results - The densitometer measures the amount of dye in the blood sample, allowing for the calculation of cardiac output based on the dilution principle.
• Step 6: Cold Thermal Dilution - In this method, cold dextrose is injected via the Swan-Ganz catheter into the right atrium. The cold fluid mixes with the blood, and the temperature change is detected by a thermistor in the pulmonary artery, allowing for cardiac output calculation using a temperature-time curve.
• Step 7: Warm Thermal Dilution - For warm thermal dilution, a Swan-Ganz catheter with a heating coil is used. A series of heat pulses are administered, and the resulting temperature changes are analyzed to determine cardiac output.

3. Post-Procedure

After the completion of the indicator dilution studies, patients may require monitoring for any potential complications related to catheter placement or the procedure itself. It is essential to observe for signs of infection, bleeding, or adverse reactions to the dye or thermal agents used. Patients may also need to be assessed for their overall cardiovascular status and any changes in symptoms. Follow-up care may include additional imaging or testing based on the results of the cardiac output measurements and the clinical context of the patient's condition.