36576 Repair of central venous access device, with subcutaneous port or pump, central or peripheral insertion site

Name of the Procedure:

Repair of Central Venous Access Device, with Subcutaneous Port or Pump, Central or Peripheral Insertion Site

Summary

This procedure involves repairing a central venous access device (CVAD) that has a subcutaneous port or pump. CVADs are used to deliver medications, fluids, or nutrients directly into a vein and are essential for patients requiring long-term intravenous therapy.

Purpose

The procedure addresses issues like malfunction, blockage, or infection of a central venous access device. The goal is to restore the functionality of the device to ensure it can efficiently deliver treatments, reduce infection risks, and improve patient comfort and quality of life.

Indications

• Malfunctioning CVAD (e.g., blockage or kinking)
• Port or pump infections
• Leaks or damages in the catheter
• Difficulties in administering medications or fluids The procedure is appropriate for patients with an existing CVAD experiencing the above conditions.

Preparation

• Patients may be required to fast for a certain period before the procedure.
• Medication adjustments, especially blood thinners, may be necessary.
• Diagnostic tests such as ultrasound or X-rays might be needed to assess the current condition of the CVAD.

Procedure Description

1. The patient is positioned appropriately, and the insertion site is sterilized.
2. Local anesthesia is administered to numb the area.
3. An incision is made if necessary to access the CVAD.
4. The CVAD, port, or pump is assessed for the issue.
5. Repairs are made, which might include replacing parts of the catheter, cleaning out blockages, or resecuring the device.
6. The incision site is then sutured or stapled closed, and a sterile dressing is applied.

Tools and Equipment:

• Sterile surgical instruments
• Imaging devices for real-time guidance (e.g., ultrasound)
• Replacement parts for the CVAD

Duration

The procedure typically takes around 30 minutes to 1 hour, depending on the complexity.

Setting

This procedure is performed in a hospital, often in a surgical suite or specialized outpatient clinic equipped with necessary imaging tools.

Personnel

• Surgeons or interventional radiologists
• Nurses
• Anesthesiologists or nurse anesthetists, if sedation is used

Risks and Complications

• Infection at the insertion site
• Bleeding or hematoma
• Damage to surrounding tissues or veins
• Device malfunction requiring further intervention Management typically involves antibiotics for infection, pressure application for bleeding, and additional procedures for severe complications.

Benefits

• Restoration of the CVAD functionality
• Reduced risk of complications associated with malfunctioning CVADs
• Improved patient comfort and quality of life Benefits are often realized immediately upon successful repair.

Recovery

• Post-procedure monitoring for signs of complications (e.g., infection, bleeding)
• Keeping the insertion site clean and dry
• Limitations on certain activities to allow healing
• Follow-up appointments to assess the CVAD functionality and insertion site healing
• Most patients can resume normal activities within a few days to a week.

Alternatives

• Replacement of the CVAD if repair isn't feasible
• Use of peripheral IV lines for short-term treatment
• Intra-osseous access for emergency situations Alternatives may have different risks, benefits, and suitability based on the patient’s condition.

Patient Experience

During the procedure, patients typically feel minimal discomfort due to local anesthesia. Post-procedure, some pain or tenderness at the site may occur, manageable with over-the-counter pain medications. Comfort measures such as ice packs and limited movement might be advised.