36581 Replacement, complete, of a tunneled centrally inserted central venous catheter, without subcutaneous port or pump, through same venous access

Name of the Procedure:

Replacement, complete, of a tunneled centrally inserted central venous catheter, without subcutaneous port or pump, through same venous access

Summary

This procedure involves replacing an existing tunneled central venous catheter (CVC) that does not have a subcutaneous port or pump. This replacement is done through the same venous access point already being used.

Purpose

The procedure addresses conditions that require long-term central venous access, such as chemotherapy, intravenous medications, or nutrition. The goal is to ensure the patient maintains a reliable and secure central line for necessary treatments.

Indications

• Malfunction or blockage of the current CVC
• Infection at the CVC site
• Damage or wear to the current CVC
• Need for a newer or different type of catheter

Preparation

• Patients may need to fast for a few hours before the procedure.
• Current medications should be reviewed; some might need to be adjusted or stopped temporarily.
• Pre-procedure blood tests to check clotting function and overall health status.
• Instruction to arrange transport home post-procedure due to sedation effects.

Procedure Description

1. Preparation: The patient is positioned, and sterile fields are prepared.
2. Anesthesia: Local anesthesia and sometimes sedation are administered.
3. Old Catheter Removal: The existing catheter is carefully removed through the established venous access.
4. Insertion of New Catheter: A new tunneled CVC is inserted into the same venous entry point.
5. Placement Confirmation: The new catheter's position is confirmed via imaging techniques like fluoroscopy or X-ray.
6. Securement: The catheter is securely sutured in place to prevent movement or dislodgment.
7. Dressing: The insertion site is dressed with a sterile bandage.

Duration

The procedure typically takes around 1 to 2 hours.

Setting

Usually performed in a hospital’s procedure room, interventional radiology suite, or sometimes an outpatient surgical center.

Personnel

• Interventional Radiologist or Surgeon
• Anesthesiologist or Nurse Anesthetist (if sedation is used)
• Nursing Staff

Risks and Complications

• Infection at insertion site
• Bleeding or hematoma
• Pneumothorax (collapsed lung)
• Thrombosis (blood clots)
• Catheter malfunction or displacement

Benefits

• Ensures continued reliable venous access for essential therapies.
• Replacement through the same access minimizes additional punctures.
• Reduces the risk of complications related to non-functioning catheters.

Recovery

• Observation for a few hours post-procedure to monitor for complications.
• Instructions for catheter care and site hygiene.
• Expected recovery time is typically 1-2 days, with some activity restrictions.
• Follow-up appointments to monitor catheter function and site healing.

Alternatives

• Peripheral intravenous lines (limited to short-term use).
• Peripherally inserted central catheter (PICC) lines.
• Implantable ports (if a port is feasible).

Patient Experience

• The procedure is generally well-tolerated with localized discomfort at the insertion site.
• Sedation helps minimize anxiety and discomfort during the procedure.
• Post-procedure tenderness and bruising at the site are common and usually resolve quickly.
• Pain management typically involves over-the-counter pain relievers unless otherwise directed by the healthcare team.