The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Ultrasound enhanced catheter-directed thrombolysis for pulmonary embolism, in June 2015.
Pulmonary embolism (PE) is a condition in which a thrombus, most commonly from a deep vein thrombosis (DVT) in the legs or pelvis, obstructs the pulmonary arterial system. Symptoms of PE depend on the extent of obstruction to the pulmonary arteries: they include chest pain, dyspnoea and haemoptysis. In severe cases PE can result in reduced cardiac output, cardiogenic shock and sudden death. Risk factors for PE include surgery, immobility, trauma, malignancy, acquired or inherited hypercoagulable states, use of oral contraceptives or hormone replacement therapy, pregnancy and dehydration.
A PE without haemodynamic instability is normally treated with low molecular weight heparin (LMWH) or fondaparinux, followed by oral anticoagulants (typically warfarin). The newer factor X inhibitors may be used without preliminary heparin. PEs with haemodynamic instability are sometimes treated with systemic thrombolysis or, occasionally, with endovascular interventions such as catheter-directed thrombolysis and percutaneous mechanical thrombectomy. Thrombolysis is associated with a risk of haemorrhagic complications including stroke. Surgical thrombectomy may occasionally be performed for patients with a life-threatening PE.
The OPCS-4 codes for ultrasound enhanced catheter-directed thrombolysis for pulmonary embolism are:
L99.4 Percutaneous transluminal venous thrombolysis NEC
Y13.5 Ultrasonic destruction of lesion of organ NOC
Y53.- Approach to organ under image control
Z40.2 Pulmonary vein
Note: Codes within category Y53.- are used as secondary codes to classify interventions that are percutaneous and require some form of image control: if the method of image control is unspecified, Y53.9 Unspecified approach to organ under image control is assigned.
In addition a code from the ICD-10 category I26 Pulmonary embolism, would be recorded.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.