36561 Insertion of tunneled centrally inserted central venous access device, with subcutaneous port; age 5 years or older

Name of the Procedure:

Insertion of Tunneled Centrally Inserted Central Venous Access Device, with Subcutaneous Port (Mediport, Port-a-Cath); Age 5 Years or Older

Summary

This procedure involves placing a central venous access device, commonly known as a port or port-a-cath, underneath the skin and into a large vein. It allows for easy long-term intravenous treatments, such as medication administration or blood draws, especially for patients who need frequent access to their veins.

Purpose

To provide a reliable, long-term intravenous access for patients requiring frequent or continuous IV therapy, blood transfusions, chemotherapy, or other long-term treatments.

Indications

• Chronic diseases requiring frequent IV medications (e.g., cancer, cystic fibrosis)
• Long-term intravenous nutrition (total parenteral nutrition)
• Regular blood transfusions
• Frequent blood tests or treatments that require venous access

Preparation

• Patients may need to fast for several hours before the procedure.
• Medication adjustments may be required (e.g., blood thinners).
• Pre-procedure tests such as bloodwork or imaging studies might be conducted.
• The patient or caregiver will receive education on the procedure and post-care.

Procedure Description

1. The patient receives local anesthesia, sedation, or general anesthesia depending on age and health.
2. An incision is made near the collarbone, and a catheter is inserted into a large central vein (e.g., the jugular or subclavian vein).
3. The catheter is tunneled under the skin to a separate port site, typically on the chest.
4. The port (a small medical appliance) is placed under the skin and connected to the catheter.
5. The port and catheter are checked for proper placement through imaging (e.g., X-ray).

Duration

The procedure typically takes about 1 to 1.5 hours.

Setting

This procedure is usually performed in a hospital, surgical center, or outpatient clinic equipped with surgical and imaging facilities.

Personnel

• Surgeon or interventional radiologist
• Anesthesiologist or anesthesia provider
• Nurses and surgical technicians

Risks and Complications

• Infection at the port or catheter site
• Bleeding or hematoma formation
• Blood clot formation
• Catheter malposition or blockage
• Allergic reaction to anesthesia or sedation
• Damage to nearby structures (e.g., blood vessels, nerves)

Benefits

• Long-term and reliable venous access
• Reduced need for needle sticks
• Facilitates frequent or continuous treatments with less discomfort
• Improves quality of life and treatment compliance

Recovery

• Patients may experience mild soreness or bruising at the incision sites.
• Instructions include keeping the area clean and dry, recognizing signs of infection, and caring for the port.
• Most patients can resume normal activities within a few days.
• Follow-up appointments will be scheduled to monitor the port function.

Alternatives

• Peripheral IV catheters: Less invasive but need frequent replacement.
• Peripherally inserted central catheter (PICC) lines: Effective for medium-term access but require more maintenance.
• External central venous catheters (Hickman, Broviac): Similar to ports but have external parts, which might be less comfortable.

Patient Experience

Patients may feel slight discomfort or pressure during the procedure. Post-procedure, they will be monitored for a few hours. Pain management strategies include medications and instructions on limiting strenuous activities to ensure proper healing. Regular follow-up will help ensure the device is functioning correctly and to manage any potential complications.