Esophageal Pressure monitoring

[sleepyjim]

To begin looking into training and getting equipment...where do I start?

[sleepguy]

Esophageal cathetar or esophageal balloon?

I don't know of a lot of labs that still do a lot of P(es). Especially when nasal pressure transducers give comperable information with a lot less mess and hassle for the patient.

[Rick]

Call the Stanford Sleep Center, they were very much in favor that all patients should have it done, they may be willing to share their procedures or at least the sources of their equipment.
Just google Stanford Sleep Center.

[linuxgeek]

Yeah, I can share it. Give me a week as I just back from San Antonio and need a little time to catch up. If I forget, PM me.

We used to do a sorta make-shift water-bag with a blood pressure cuff wrapped around the bag, all on an IV pole with an infant catheter (which we cut extra holes in) thru the nose.

But now we use the Cooper Surgical balloon which Braebon distributes and connect it to the Braebon 0580-Pes transducer.

There is some info that comes along with the Braebon package that is pretty much what we do.

We rarely do the procedure now, and only a handful of labs probably do this now.

[somnonaut]

What the hell process are you all talking about?
"...make-shift water-bag with a blood pressure cuff wrapped around the bag, all on an IV pole with an infant catheter (which we cut extra holes in) thru the nose. "

[linuxgeek]

lol.

It's a water-drip pressure system.

Attached is the article outlining the procedure we used to do.

It's more complicated than the current balloon. I would change the design of the balloon if I had a choice, but there's no way I'm going to convince anyone to change the design of it.

[redbull26]

We have been doing PES at our sleep labs in Houston for several years now under the direction of Dr. Jerald Simmons. We have been able to make many diagnosis where otherwise the patient would have slipped under the radar. I highly suggest (if you have the means and the know how) getting one for your labs... You would be pleasently suprised in the outcome. Plus the reambursement isnt bad. Win win

[linuxgeek]

Dr. Simmons, as I understand it, was the one who was responsible for moving Pes recording from research to clinical practice at Stanford.

We don't get paid anymore for it. Do you know how you bill for it?

[Gizmo]

I haven't used Pes since 1998, thank goodness. It wasn't much fun for the pt or the tech to make a polysomnogram an invasive procedure. We had to remove the Pes many times in the middle of the night d/t pts complaining about the discomfort.

Back in 1997, I attended a week-long course in Palo Alto, CA and we were able to visit the Stanford Sleep Center. They (at that time) inserted a Pes on every pt right before lights out. I wonder if they are still doing this ... ?

[redbull26]

Im pretty sure Stanford is still doing it and we bill for Esophogus motility Study... Cant remember what the cpt code is for it. By the way, it is a minimally invasive procedure with great diagnostic perspective. Typically, we pull the pes 1/2 way through the night for comfort and to rule out the possibility of the tube stimulating the esophagus to keep open. Its a great tool to have in the lab when you need it.

[linuxgeek]

Yes, we do it occasionally at Stanford.

We did used to do it on every patient. To put that in perspective, the rest of the sleep world was using thermocouples when we were doing that.

I don't know if a motility study is accurate, but I might look into that.

[Rick]

Redbull, you are adding an extra CPT code to the code for the PSG? Doesn't the Pes take the place of measuring effort? Do you still monitor airflow with pressure and thermal; and respiratory effort by RIP?
Point being that if this procedure is taking the place of something that is supposed to be included in the PSG CPT code then it should not be charged for, or you shouldn't use the PSG CPT if you don't measure all of the parameters that are required.
This sounds like charging extra for monitoring EtCO2, or calling the Flow-Volume loops from some RIP systems a PFT and charging extra for that, there could be problems with an extra charge that should be covered by the PSG CPT. Monitoring this extra parameter is not required, but is your standard practice for a PSG, then the PSG CPT should cover items monitored as routine.
I am just cautioning; I remember before the CPT codes were bundled, it was a major pain to code each and every little facet for billing purposes. I cheered when they were bundled; but I also cheered when heated humidity was introduced to CPAP, so go figure.

[slowdavesleep]

About 5 years ago, maybe more I set up esophageal catheter recording according to that article. It was a fun project. Of course the move to use it on patients got vetoed but I still got to play with the arterial blood pressure transducer and saline drip as well as catheterizing myself several times while testing the unit.

[slowdavesleep]

Lately I hear about pharyngeal catheters in sleep. Anyone using those?

[sleepguy]

About 5 years ago, maybe more I set up esophageal catheter recording according to that article. It was a fun project. Of course the move to use it on patients got vetoed but I still got to play with the arterial blood pressure transducer and saline drip as well as catheterizing myself several times while testing the unit.

First played around with it in the early/mid 90's. Our Sleep/neuro doc wanted to start doing it and got the hospital to buy the equipment. I told him that since we have zero experience with it, he is going to be our guinea pig. I got the cathetar inserted OK, and calibrated OK. He had a very fit-full night sleeping. In the morning he said the cathetar hurt more as the night wore on. It was then that we realized I had not removed the guidewire.