36585 Replacement, complete, of a peripherally inserted central venous access device, with subcutaneous port, through same venous access

Name of the Procedure:

Replacement, complete, of a peripherally inserted central venous access device (PICC), with subcutaneous port, through the same venous access.

Summary

This procedure involves removing an existing peripherally inserted central venous access device (PICC line) and replacing it with a new one that includes a subcutaneous port. The new device is inserted through the same vein used for the original PICC line.

Purpose

The procedure is used to maintain long-term intravenous (IV) access for patients who require ongoing medication administration, nutritional support, or frequent blood draws. The goal is to ensure a reliable and long-lasting venous access point that reduces the risk of infection and other complications.

Indications

• Chronic conditions requiring long-term IV therapy (e.g., chemotherapy, antibiotic therapy).
• Frequent need for blood sampling.
• Existing PICC line no longer functioning or is infected.
• Need for a more durable and less maintenance-intensive IV access device.

Preparation

• Patients may need to fast for several hours before the procedure.
• Instructions to stop certain medications, particularly blood thinners, might be provided.
• Blood tests and imaging studies (e.g., ultrasound) might be performed to assess the vein.

Procedure Description

1. The patient is positioned for comfortable access to the insertion site.
2. Local anesthesia is administered to numb the area.
3. The old PICC line is carefully removed.
4. The same venous access point is prepared for the new device.
5. The new catheter is inserted through the vein and guided to the appropriate location near the heart.
6. A subcutaneous pocket is created under the skin to place the port.
7. The catheter is connected to the port, ensuring it remains firmly in place.
8. The incision is closed, and the area is dressed with sterile bandages.

Duration

The procedure typically takes between 1 to 2 hours to complete.

Setting

The procedure is performed in a hospital or an outpatient surgical center.

Personnel

• Interventional radiologist or a vascular surgeon
• A nurse to assist with the procedure and patient care
• An anesthesiologist or nurse anesthetist, if sedation is used

Risks and Complications

• Infection at the insertion site
• Bleeding or bruising
• Difficulty inserting the new catheter
• Blood clot formation
• Rare risk of damage to surrounding tissues or organs

Benefits

• Provides a dependable, long-term solution for IV access.
• Reduced need for frequent needle sticks.
• Lower risk of infection compared to traditional PICC lines.
• More comfortable for patients needing prolonged or intermittent IV therapy.

Recovery

• Patients may have mild discomfort at the insertion site.
• Instructions will be provided on how to care for the insertion site to prevent infection.
• Most patients can resume normal activities within a few days.
• Follow-up appointments will be necessary to ensure proper device function.

Alternatives

• Insertion of a new PICC line without a subcutaneous port.
• Use of a tunneled central venous catheter.
• Implantation of an entirely different type of central venous access device.
• Each alternative has its own set of benefits and risks, which should be discussed with the healthcare provider.

Patient Experience

• Patients may feel minor pain or pressure during the local anesthetic injection.
• The insertion area might be tender for a few days.
• Pain management options, including over-the-counter pain relievers, will be provided to ensure comfort during recovery.
• Patients should expect some follow-up and ongoing care to monitor the new device.