36815 Insertion of cannula for hemodialysis, other purpose (separate procedure); arteriovenous, external revision, or closure

Name of the Procedure:

Insertion of Cannula for Hemodialysis, Other Purpose (Separate Procedure); Arteriovenous, External Revision, or Closure

Summary

This procedure involves the insertion, revision, or closure of an arteriovenous (AV) cannula used for hemodialysis. It is often necessary to ensure proper dialysis treatment, allowing efficient removal of waste and excess fluid from the blood.

Purpose

The procedure addresses issues related to inefficient or problematic AV fistulas or grafts used for hemodialysis. The goals are to establish a reliable access point for hemodialysis, correct complications or blockages in the existing access, and maintain or restore effective dialysis treatment.

Indications

• Chronic kidney disease requiring hemodialysis.
• Malfunctioning or thrombosed AV fistulas or grafts.
• Infections or other complications at the AV access site.
• Poor blood flow or inadequate dialysis efficiency.

Preparation

• Patients may need to fast for a few hours before the procedure.
• Adjustments in medications, especially blood thinners, may be required.
• Blood tests and imaging studies (e.g., ultrasound, angiography) may be conducted to assess the AV access site.

Procedure Description

1. The patient is positioned and prepped in a sterile manner.
2. Local anesthesia or sedation is administered to ensure comfort.
3. An incision is made at the AV access site.
4. Depending on the necessity, the cannula is either inserted, revised, or closed.
5. For insertions, a synthetic tube is placed between an artery and a vein.
6. For revisions, blockages or issues within an existing AV access are corrected.
7. For closures, the AV access is sealed off if it's no longer needed.
8. The incision is closed with sutures, and a sterile dressing is applied.

Duration

Typically, the procedure takes about 1 to 2 hours.

Setting

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

Personnel

• Vascular surgeons or interventional radiologists perform the procedure.
• Nurses and anesthesiologists assist with patient care and anesthesia.

Risks and Complications

• Infection at the incision site.
• Bleeding or hematoma formation.
• Blood clot formation within the AV access.
• Damage to the blood vessels or surrounding structures.
• Anesthesia-related complications.

Benefits

• Improved efficiency and effectiveness of hemodialysis.
• Reduced risk of dialysis-related complications.
• Enhanced quality of life for patients requiring long-term dialysis.

Recovery

• Patients are monitored for a few hours post-procedure.
• Care instructions include keeping the site clean and dry.
• Avoid heavy lifting or strenuous activities for a few weeks.
• Follow-up appointments to monitor the access site and dialysis effectiveness.

Alternatives

• Peritoneal dialysis.
• Continued use of an existing but functional AV access.
• Central venous catheter placement.

Patient Experience

• Mild discomfort or pain at the incision site managed with pain medication.
• Pressure or tightness may be felt at the access site during healing.
• Some patients may experience bruising or swelling, which typically resolves within a few days.

This markdown description provides a comprehensive overview of the procedure, ensuring clarity and understanding for patients and healthcare providers alike.