204 REPAIR UNILATERAL or BILATERAL CLEFT LIP

                with or without REPAIR ANTERIOR HARD PALATE (AHP)

usually includes 220 PE tubes by Dr. Horn, always includes 221 Video Scope and Tower Setup

 updated June 5, 2016

 

ICD10 CODES:

  Q37.9 UNILATERAL CLEFT LIP & PALATE

  Q37.8 BILATERAL CLEFT LIP & PALATE

CPT CODES:

    40700 REPAIR UNILATERAL CLEFT LIP

    40701 REPAIR BILATERAL CLEFT LIP

    42235 REPAIR ANTERIOR HARD PALATE

 

ANESTHESIA NOTES

■ regular ET tube (no RAE)

■ long circuit

■ straight anesthesia connector

■ Dr. C to start IV and sew in tube with 2-0 silk

■ IV pump in room and charging

■ temp probe

■ Kefzol IV 25mg/kg; Decadron 0.5mg/kg

PATIENT POSITION | SETUP

■ Will turn bed counter clockwise after PE tubes

■ Dr. C to suture tube with 2-0 silk SH,

■ Rolled terry cloth towel under shoulders

■ Large round gel doughnut under head (no cover)

■ Pedi-wrap elbow restraints with D-ring (neonate size)

■ Pedi Baer hugger #555

■ blanket, green towels ■ 1" tape to secure tube

TABLE POSITION

Lower foot, close head gap, Do Not Remove Head Piece

Large round gel donut head rest. Place Baer after turning.

ROOM SETUP

Warm room 72o, warm bed and head rest w/ Baer

Separate mayo stand for video equip

 

EQUIPMENT and SPECIALS


● Dr. C light source w/headlight

● Baer hugger

IV pump plugged in

Video tower and 2nd slave monitor

Omni Lapotrac scope holder and bed clamp

● 3.5mm Endoscope, camera, light cord.

PREP

PCMX with minimal water, cotton tip applicators to clean nose, wipe gently inside mouth, lightly over eyelids

DRAPING and PACKS

Cleft Palate Custom Pack, Towel Pack, White towels

Head sheet (two green towels and a ¾ sheet), ¾ sheet,

magnetic pad, rigid box for bovie, towel clips,

½” steri-strip for eyes, 1000 drape, 2" Kling for pharyngeal pack

CAUTERY

Bovie 8/8 pure, [1] Colorado tip, [1] 0118A Megadyne needle point tips, [2] holsters

SUCTION x 2

[1] 7fr Frazier tip and [1] Sontec peds fluted suction

[1] 10fr NG suction catheter for end of case to suction stomach

 

SOLUTIONS | IRRIGATION

Kefzol irrigation 500mg/500cc NS, saline, water

NEEDLES | SYRINGES

[2] 3cc syringe, [1] 30cc syringe,

[4] 30g needle 5/8", [1] 12g angiocath

LOCAL ANESTHETIC

peds mixture: 50/50 - Mix in 3cc syringe with 30g needle x 2

    • 1% lidocaine w/ epi 1:100,000 and

    • 0.5% Ropivicaine plain

MEDICATIONS

■ methylene blue in prep cup for tattooing lip

■ Kefzol for irrigation

■ Bacitracin ointment

***for bleeding have available from anesthesia***

neosynephrine 0.2cc in plastic cup




 

204 REPAIR UNILATERAL or BILATERAL CLEFT LIP

                with or without REPAIR ANTERIOR HARD PALATE (AHP)


page 2

 

SETS TO OPEN Dr. C Cleft Lip / Fine Instrument Set / Basin Set

INSTRUMENTS USED (ON MAYO STAND) - 2 mayo stands

     FORCEPS

Packing forceps, [3] Cushings, 05 Adson, .5 TC gold CV fine,

0.5 silver Sontec CV fine, 0.5 titanium

     SCISSORS

Gradle, fine, straight tenotomy, curved tenotomy, Iris, Stevens

     NEEDLE HOLDERS

[4] Angled palate, [3] Castroviejos, smooth Webster

     RETRACTORS

Millard-Dingman mouth gag,

2mm, 5mm, 10mm skin hooks, Ragnell

     KNIFE | BLADES

[4] 30° super sharp blades #7531, [2] 15 BP scalpel blades

     ELEVATORS

McCullough, Hockey stick, Tebbetts

OTHER

calipers, blue silicone cup, plastic med glasses

 

STERILE SUPPLIES

▪ [2] marking pens with ruler

▪ bacitracin ointment

▪ non-disposable light handles

▪ methylene blue

▪ med glasses

▪ defogger

▪ ½" steri-strips for eyes

▪ 10fr suction catheter

▪ [3] 3" cotton tip applic

▪ 7½ Protegrity latex gloves

 

HOLD ▪ Gelfoam (surgifoam #1972)

HOLD ▪ Surgicel 2"x14" #1951

SPONGES, etc.

4x4 Raytec, 2" Kling for pharyngeal pack,

[3] 3" cotton tip applicators, towel pack

NON-STERILE SUPPLIES

Pedi Baer hugger #555, Pedi-Wrap arm restraints neonatal

 

 

No

Type

SN

status

SUTURES

[ 1 ]

2-0 Silk SH

K 833

open

 

[ 8 ]

4-0 Chromic P3

1654

open 6

hold 2

[ 2 ]

5-0 Chromic P-3

687

open

 

[ 2 ]

6-0 Chromic G-1single

796

open

 

[ 2 ]

4-0 Monocryl RB1

Y214

 

hold 2

[ 1 ]

5-0 Monocryl TF

Y433

open

 

[ 1 ]

6-0 Monocryl P-1

Y489

open

 

[ 1 ]

6-0 Prolene P-1

8697

 

hold

[ 1 ]

7-0 PDS BV-1

Z 135

 

hold

[ 2 ]

7-0 Prolene P-6

8648

open 1

hold 1

 

DRESSINGS

none - bacitracin to wound, remember to remove pharyngeal pack and cut suture, 10fr suction catheter to suction stomach.

 

POSTOPERATIVE

call for pediatric crib (6th floor), 2 warm blankets in corral shape, connect IV infuser before moving baby, oxygen for transport

NOTES

may not include anterior hard palate, may not have PE tubes,

all cases will have video monitoring.

 

DATES MODIFIED

2006, 2007, 2008, 2009, Jan 2010, Aug 2012, Jan 2013, Sep 2015, Jun 2016