36583 Replacement, complete, of a tunneled centrally inserted central venous access device, with subcutaneous pump, through same venous access

Name of the Procedure:

Replacement, complete, of a tunneled centrally inserted central venous access device, with subcutaneous pump, through same venous access (Tunneled CVC with Subcutaneous Pump Replacement)

Summary

This procedure involves the replacement of a tunneled central venous catheter (CVC) that is connected to a subcutaneous pump. The new device is inserted through the same vein where the old device was located. This central line helps with long-term medication delivery, nutrition, or blood drawing.

Purpose

The procedure addresses the need to replace a malfunctioning or infected central venous access device. The goal is to ensure continued reliable access to a central vein for long-term treatments such as intravenous medications, chemotherapy, parenteral nutrition, or frequent blood draws.

Indications

• Malfunctioning or blocked CVC
• Infection around the current CVC
• Need for long-term intravenous treatment
• Patient criteria include previous successful central line placement, absence of severe coagulopathy, and overall condition permitting surgical procedure.

Preparation

• Fasting for at least 8 hours before the procedure if sedation or general anesthesia is to be used.
• Instructions to stop certain medications like blood thinners, as directed by the physician.
• Blood tests including complete blood count (CBC), coagulation profile, and sometimes imaging studies to confirm the position of the current catheter.

Procedure Description

1. The patient is positioned comfortably, often lying down, and the insertion area is cleaned and sterilized.
2. Local anesthesia is administered to numb the area; sedation or general anesthesia may be provided depending on patient comfort.
3. The existing tunneled CVC is carefully removed.
4. The same venous access site is used to insert a guidewire.
5. The new CVC with a subcutaneous pump is threaded over the guidewire and positioned correctly.
6. The catheter is tunneled under the skin to the desired exit site.
7. The subcutaneous pump is implanted and connected to the catheter.
8. The insertion site is sutured, dressed, and the device is checked for proper function.

Duration

Approximately 1 to 2 hours, depending on patient-specific factors and complexity.

Setting

Performed in a hospital operating room or specialized outpatient surgical center.

Personnel

• Vascular surgeon or interventional radiologist
• Nurse(s) and/or surgical technician(s)
• Anesthesiologist or nurse anesthetist (if sedation or general anesthesia is used)

Risks and Complications

• Infection
• Bleeding or hematoma
• Thrombosis (blood clots)
• Catheter malfunction or malposition
• Pneumothorax (collapsed lung)
• Need for additional procedures if complications occur

Benefits

• Restores reliable venous access for necessary treatments.
• Reduces the need for frequent needle sticks.
• Potential for fewer complications compared to repeated peripheral IV insertions.
• Immediate resumption of the required intravenous treatments.

Recovery

• Monitoring in a recovery area shortly after the procedure.
• Instructions to keep the insertion site clean and dry.
• Pain management typically with over-the-counter pain relievers, though stronger medications can be prescribed if necessary.
• Follow-up appointments to ensure proper function and to monitor for any complications.
• Recovery time is usually minimal, but activity might be restricted for 24-48 hours.

Alternatives

• Peripheral IV lines, though less reliable for long-term use.
• Peripherally inserted central catheters (PICCs).
• Other types of central venous catheters like non-tunneled or port-a-cath systems.
• Pros and cons depend on patient needs and underlying health conditions, with alternatives often offering different benefits and risks.

Patient Experience

During the procedure, the patient may feel pressure but should not experience pain due to anesthesia. Post-procedure, there might be localized pain or discomfort managed with pain relievers. The patient may need to limit physical activities for a short period and follow care instructions carefully to avoid infection and other complications.