Replacement, complete, of a non-tunneled centrally inserted central venous catheter, without subcutaneous port or pump, through same venous access
CPT4 code
Name of the Procedure:
Replacement, complete, of a non-tunneled centrally inserted central venous catheter (CVC), without subcutaneous port or pump, through same venous access.
Summary
This procedure involves removing an existing non-tunneled central venous catheter (CVC) and replacing it with a new one using the same venous access point. This type of CVC does not have a tunnel under the skin or a subcutaneous port or pump.
Purpose
The purpose of this procedure is to maintain venous access for patients requiring long-term intravenous medications, nutrition, chemotherapy, or blood draws. It addresses issues such as catheter infection, blockage, or displacement.
Indications
- Infection of the existing CVC.
- Mechanical issues such as blockage, kinking, or displacement of the CVC.
- Routine scheduled replacement to prevent complications.
- Persistent or frequent issues with the current CVC.
Preparation
- Patients may need to fast for a few hours before the procedure, especially if sedation or anesthesia is required.
- Adjustments to medications (such as blood thinners) might be necessary.
- Diagnostic tests such as blood work or imaging studies to assess the current catheter position and patient's overall health.
Procedure Description
- The patient is positioned comfortably on an examination table.
- The area around the existing CVC site is cleaned and sterilized.
- Local anesthesia is administered to numb the area.
- The existing CVC is carefully removed.
- A guidewire is inserted through the same venous access point.
- Over the guidewire, the new CVC is threaded and placed into the correct position.
- The guidewire is removed, and the new CVC is secured.
- The new catheter site is cleaned, and a sterile dressing is applied.
- The catheter is tested to ensure proper blood flow and function.
Duration
The procedure typically takes about 30 minutes to an hour, depending on complexity and patient-specific factors.
Setting
The procedure is usually performed in a hospital or an outpatient clinic setting.
Personnel
- Interventional radiologist or a specially trained healthcare provider
- Nursing staff
- Possible involvement of an anesthesiologist if sedation is used
Risks and Complications
- Infection at the catheter site
- Bleeding or hematoma formation
- Air embolism
- Thrombosis (blood clot formation)
- Catheter misplacement
- Potential for nerve damage
Benefits
- Continual medication and treatment administration via a central line.
- Reduction in the need for repeated venous sticks.
- Immediate access to the central venous system for medication, nutrition, or blood draws.
Recovery
- Post-procedure monitoring for a few hours to ensure there are no immediate complications.
- Instructions to keep the catheter site clean and dry.
- Guidelines on how to care for the central line at home.
- Follow-up appointments to monitor for complications and ensure the catheter is functioning correctly.
- Most patients can resume normal activities within a day with some limitations on strenuous activities.
Alternatives
- Peripheral intravenous (IV) access - suitable for short-term use.
- Other types of central venous catheters, such as tunneled CVCs or those with subcutaneous ports.
- Pros of alternatives can include longer duration between replacements or reduced infection rates; cons may include more complex insertion procedures or less convenience for certain treatments.
Patient Experience
- During the procedure: Patients may feel pressure or slight discomfort when the existing catheter is removed and the new one is inserted.
- After the procedure: Patients might experience some soreness or bruising at the insertion site.
- Pain management: Local anesthesia minimizes pain during the procedure; post-procedure pain can typically be managed with over-the-counter analgesics.
- Detailed instructions will be provided to ensure the patient's comfort and optimal recovery.