36903 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, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis.

Summary

This procedure involves inserting needles or catheters into a dialysis circuit to perform a diagnostic angiography. This imaging technique uses contrast dye to visualize the blood vessels and detect any issues with the dialysis access point.

Purpose

The procedure addresses problems with dialysis access, ensuring that the dialysis circuit is functioning properly and detecting any blockages or narrowing of the blood vessels. The goal is to ensure efficient and effective dialysis treatment.

Indications

• Unexplained poor dialysis efficiency
• Suspected blockages or narrowing in the dialysis access
• Swelling, pain, or changes in the performance of the dialysis fistula or graft
• Routine surveillance of dialysis access function

Preparation

• Patients may be required to fast for several hours before the procedure.
• Inform the healthcare provider of any medications being taken; some may need to be adjusted or stopped.
• Blood tests to check kidney function and clotting parameters may be required.

Procedure Description

1. The patient is positioned comfortably, and the access site is cleaned and sterilized.
2. Local anesthesia is administered to numb the area, sometimes sedation is given.
3. A needle is inserted into the dialysis access point (fistula or graft), followed by a catheter.
4. Contrast dye is injected through the catheter.
5. X-ray imaging (fluoroscopy) is used to visualize the dialysis circuit.
6. Any detected problems can be revised immediately if needed (e.g., angioplasty to dilate narrowed vessels).
7. The catheter is removed, and pressure is applied to the puncture site to prevent bleeding.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

The procedure is usually performed in a hospital interventional radiology suite or a specialized outpatient clinic.

Personnel

• Interventional radiologist or vascular surgeon
• Radiology technologists
• Nursing staff
• Anesthesiologist (if sedation is used)

Risks and Complications

• Pain at the puncture site
• Infection
• Bleeding or hematoma
• Allergic reaction to the contrast dye
• Vessel damage or clot formation
• Rarely, kidney damage from the contrast dye

Benefits

• Identification and correction of issues with the dialysis access
• Improved dialysis efficiency and patient outcomes
• Minimally invasive with a relatively quick recovery

Recovery

• Patients may need to stay for observation for a few hours post-procedure.
• Avoid strenuous activities for 24-48 hours.
• Keep the puncture site clean and dry.
• Follow any specific instructions provided by the healthcare team regarding medications and activities.
• Schedule a follow-up appointment to ensure proper healing and dialysis function.

Alternatives

• Ultrasound or MRI to visualize the dialysis circuit without using contrast dye.
• Physical examination and monitoring of dialysis performance indicators.
• Surgical revision if non-invasive techniques are insufficient.

Patient Experience

• Mild discomfort or pressure may be felt during needle insertion.
• Warmth or a flushing sensation may occur when the contrast dye is injected.
• Post-procedure, some soreness or bruising at the puncture site is common.
• Pain is usually managed with over-the-counter pain relievers.
• Patients can expect to resume normal activities within a couple of days, following specific instructions from the healthcare provider.