36566 Insertion of tunneled centrally inserted central venous access device, requiring 2 catheters via 2 separate venous access sites; with subcutaneous port(s)

Name of the Procedure:

Insertion of Tunneled Centrally Inserted Central Venous Access Device, Requiring 2 Catheters via 2 Separate Venous Access Sites with Subcutaneous Port(s)

Summary

In this procedure, two catheters are inserted into separate veins and tunneled under the skin to reach a central vein near the heart. Small devices called ports are placed under the skin, allowing easier long-term access to the bloodstream for medications or nutrients.

Purpose

This procedure addresses conditions requiring frequent or long-term access to the bloodstream, such as chemotherapy, long-term antibiotic therapy, or parenteral nutrition. The primary goal is to provide a reliable and convenient venous access point while minimizing infection risks.

Indications

• Long-term intravenous (IV) treatments (e.g., chemotherapy)
• Severe nutritional deficiencies requiring parenteral nutrition
• Hemodialysis
• Frequent blood sampling or transfusions
• Difficulties with peripheral venous access

Preparation

• Fasting for several hours as instructed.
• Adjustments to medications, especially blood thinners.
• Pre-procedure blood tests and imaging studies to assess vein condition.
• Consultation with the healthcare team to review allergies and medical history.

Procedure Description

1. The patient is positioned and the insertion sites are cleaned and sterilized.
2. Local anesthesia or sedation is administered.
3. Two small incisions are made for venous access.
4. The catheters are inserted into the veins and tunneled under the skin to a central vein.
5. Ports (small devices) are placed beneath the skin, typically on the chest.
6. The incisions are closed with sutures or staples and covered with sterile dressings.
7. Proper placement is confirmed using imaging techniques like X-ray.

Duration

The procedure typically takes 1-2 hours.

Setting

Performed in a hospital's interventional radiology suite, operating room, or an outpatient surgical center.

Personnel

• Interventional radiologist or surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurses and technologists

Risks and Complications

• Infection at the insertion site
• Blood vessel or organ injury
• Bleeding or hematoma formation
• Catheter dysfunction or displacement
• Blood clots (thrombosis)
• Allergic reactions to anesthesia or contrasts

Benefits

• Reliable long-term venous access
• Reduced need for repeated needle sticks
• Decreased risk of vein irritation and damage
• Ease of administering treatments and drawing blood

Recovery

• Monitor for signs of infection or complications at the insertion sites.
• Avoid heavy lifting or strenuous activity for several days.
• Follow-up appointments for port care and management.
• Resume normal activities within 1-2 weeks, as directed by the healthcare provider.

Alternatives

• Peripherally inserted central catheter (PICC line)
• Peripheral IV lines
• Implanted vascular access devices without ports
• Pros: Some alternatives are less invasive.
• Cons: May not be suitable for long-term use or frequent access.

Patient Experience

• Mild discomfort or pain at the incision sites, managed with prescribed pain relievers.
• Potential feeling of heaviness or pressure in the chest area due to ports.
• Instructions on how to care for the ports and recognizing signs of complications.
• Gradual improvement in comfort and ease of use as the body adjusts to the device.