36902 Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis

Name of the Procedure:

Introduction of Needle(s) and/or Catheter(s), Dialysis Circuit, with Diagnostic Angiography of the Dialysis Circuit

Summary

This procedure involves inserting needle(s) or catheter(s) into a dialysis circuit to perform diagnostic imaging (angiography). This helps identify any issues such as blockages or narrowing in the blood vessels used for dialysis.

Purpose

The main goal is to diagnose and evaluate any problems in the dialysis circuit. This ensures that the blood flow needed for dialysis is unobstructed and functioning properly.

Indications

• Poor dialysis efficacy
• Suspected blockage or narrowing of the dialysis circuit
• Swollen arm near the dialysis site
• Unusual or prolonged bleeding after dialysis
• High venous pressures during dialysis sessions
• Unexplained changes in blood pressure during dialysis

Preparation

• Fasting for 6-8 hours before the procedure
• Informing the healthcare provider of all current medications
• Possibly stopping blood thinners as advised by the doctor
• Pre-procedure blood tests to assess kidney function and clotting status

Procedure Description

1. Preparation: The patient is positioned and the skin is sterilized.
2. Anesthesia: Local anesthesia is applied to numb the insertion site.
3. Needle/Catheter Insertion: A needle or catheter is introduced into the dialysis circuit via direct puncture.
4. Contrast Injection: A contrast dye is injected to visualize the blood vessels.
5. Imaging: X-rays or fluoroscopic images are taken from the arterial anastomosis to evaluate the blood flow and identify any issues.
6. Assessment: Based on the images, the healthcare provider determines if any intervention is needed.

Duration

The procedure typically takes around 1-2 hours.

Setting

This procedure is usually performed in a hospital’s radiology suite or an outpatient clinic equipped with imaging facilities.

Personnel

• Interventional Radiologist or Vascular Surgeon
• Radiology Technician
• Nursing staff
• Anesthesiologist (if sedation is required)

Risks and Complications

• Possible bleeding at the puncture site
• Infection
• Allergic reaction to the contrast dye
• Blood vessel damage
• Clot formation in the dialysis circuit
• Rare risk of kidney damage from the contrast dye

Benefits

• Accurate diagnosis of problems in the dialysis circuit
• Improved dialysis efficiency and patient safety
• Avoidance of potential complications from untreated blockages

Recovery

• Monitoring in a recovery area for a few hours
• Keeping the puncture site clean and dry
• Avoiding strenuous activities for 24-48 hours
• Follow-up appointments to review the results and plan further treatment if needed

Alternatives

• Duplex ultrasonography
• MRI angiography (MRA)
• CT angiography (CTA)
• Each alternative has its own advantages, such as being non-invasive, but may not offer the same detailed imaging as diagnostic angiography.

Patient Experience

• Mild discomfort or pressure at the insertion site
• Possible sensation of warmth when the contrast dye is injected
• Pain management with local anesthesia and, if needed, sedation during the procedure
• Mild soreness at the puncture site post-procedure, monitored and managed by healthcare professionals