Mechanical removal of intraluminal (intracatheter) obstructive material from central venous device through device lumen
CPT4 code
Name of the Procedure:
Mechanical removal of intraluminal (intracatheter) obstructive material from central venous device through device lumen (Intraluminal Thrombectomy or Catheter Clearing)
Summary
In this procedure, a special device is used to clear any obstructions or blockages inside a central venous catheter. The blockage could be blood clots or other materials that prevent the catheter from working correctly.
Purpose
The goal is to restore the proper function of the central venous catheter, which is often used for delivering medications, nutrients, or for blood sampling. This procedure addresses blockages that can compromise the effectiveness of the catheter.
Indications
- Signs of catheter dysfunction, such as difficulty in drawing blood or administering fluids.
- Diagnosed thrombus or other obstructive material within the catheter.
- Patients who rely on the central venous device for critical treatments, such as chemotherapy, parenteral nutrition, or dialysis.
Preparation
- Patients may need to fast for a few hours prior, depending on the type of sedation used.
- Medication adjustments, particularly blood thinners, may be necessary.
- Pre-procedure imaging tests like an ultrasound or X-ray may be performed to locate the obstruction.
Procedure Description
- The patient is usually positioned comfortably, and the catheter site is cleaned and prepped in a sterile manner.
- Local anesthesia or mild sedation may be administered.
- A special tool, often a mechanical thrombectomy device, is inserted into the catheter lumen.
- The device is then carefully manipulated to capture and remove the obstructive material.
- The catheter may be flushed with saline to ensure it is clear and functioning.
- The site is then bandaged, and the patient is monitored for a short period.
Duration
The procedure typically takes about 30 minutes to an hour.
Setting
The procedure is usually performed in a hospital's interventional radiology suite or a specialized outpatient clinic.
Personnel
- An interventional radiologist or a specially trained physician performs the procedure.
- Nurses or technologists assist and monitor the patient.
Risks and Complications
- Infection at the catheter site.
- Bleeding or hematoma formation.
- Damage to the catheter or blood vessel.
- Rarely, dislodging of the obstructive material leading to pulmonary embolism.
Benefits
- Restoration of catheter function.
- Avoidance of catheter replacement, which is a more invasive procedure.
- Immediate resumption of necessary treatments.
Recovery
- Patients can usually go home the same day.
- Minimal post-procedure discomfort is expected; over-the-counter pain relievers can be taken if needed.
- Instructions will include keeping the catheter site clean and dry.
- Follow-up appointments may be scheduled to monitor catheter function.
Alternatives
- Enzyme (thrombolytic) treatment to dissolve the clot.
- Catheter replacement if mechanical clearing is unsuccessful or not feasible.
- Each alternative has its pros and cons, such as longer time for thrombolytic therapy to take effect or higher invasiveness for catheter replacement.
Patient Experience
- Patients may feel slight discomfort or pressure during the procedure.
- Mild pain or tenderness at the catheter site post-procedure is common but manageable.
- Instructions and support for keeping the catheter site clean and recognizing signs of complications will be provided.