Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; removal of peripheral (arterial and/or venous) cannula(e), percutaneous, 6 years and older
CPT4 code
Name of the Procedure:
Extracorporeal Membrane Oxygenation (ECMO)/Extracorporeal Life Support (ECLS) Removal of Peripheral (Arterial and/or Venous) Cannula(e), Percutaneous, 6 Years and Older
Summary
This procedure involves the removal of cannulae (tubes) that have been inserted into a patient's blood vessels (arterial and/or venous) for ECMO or ECLS. ECMO/ECLS is a life-support technique used to oxygenate and pump blood outside of the body. The removal process is performed percutaneously (through the skin) and is applicable to patients aged 6 years and older.
Purpose
The procedure addresses the cessation of ECMO/ECLS support once the patient's heart and/or lungs have sufficiently recovered. The goal is to safely remove the cannulae to eliminate the risk of infection or other complications associated with prolonged insertion.
Indications
- Recovery of heart and/or lung function to the extent that ECMO/ECLS support is no longer needed.
- Patient stabilization with the ability to sustain vital functions without extracorporeal support.
- Age: 6 years and older.
Preparation
- The patient may be required to undergo fasting for a few hours before the procedure.
- Medication adjustments might be necessary, as advised by the physician.
- Pre-procedure diagnostic tests may include blood work, imaging studies, and a thorough physical examination to confirm stability and readiness for cannula removal.
Procedure Description
- The patient is positioned comfortably, and the cannula site is sterilized.
- Local anesthesia or sedation may be administered to minimize discomfort.
- The physician carefully removes the cannulae using percutaneous techniques, which involve small incisions or punctures in the skin.
- Pressure is applied to the site to control bleeding.
- The site is then cleaned and dressed to promote healing and prevent infection.
Duration
The procedure typically takes around 30 to 60 minutes.
Setting
This procedure is usually performed in a hospital setting, often in an intensive care unit (ICU) or a specialized procedural area.
Personnel
- Physician (typically a cardiothoracic surgeon or specialist in critical care medicine)
- Nurses
- Anesthesiologist or sedation specialist (if applicable)
Risks and Complications
- Bleeding at the cannula site
- Infection
- Blood clots
- Skin or tissue damage at the insertion sites
Benefits
- Removal of foreign materials and the associated infection risk
- Transition towards complete recovery and independence from life-support systems
- Improvement in patient comfort and mobility
Recovery
- Immediate post-procedure care includes monitoring for bleeding and signs of infection.
- Patients may need to rest for a few hours.
- Follow-up appointments to ensure proper healing and recovery.
- Specific instructions on wound care and activity limitations.
Alternatives
- Continue ECMO/ECLS support if the patient is not yet stable.
- Transition to other forms of mechanical ventilation or support if partial assistance is still required.
Patient Experience
- The patient might feel slight discomfort or pressure during cannula removal, but local anesthesia or sedation typically minimizes pain.
- Post-procedure, there may be some tenderness or bruising at the site.
- Pain management will be provided, and comfort measures such as dressings will be used to ensure proper healing.