49419 Insertion of tunneled intraperitoneal catheter, with subcutaneous port (ie, totally implantable)

Name of the Procedure:

Insertion of Tunneled Intraperitoneal Catheter with Subcutaneous Port (ie, Totally Implantable)

Summary

This procedure involves placing a special catheter inside the abdomen which is tunneled under the skin and connected to a small port. The port is implanted under the skin and allows for the administration of fluids and medications directly into the peritoneal cavity.

Purpose

• Medical Condition: Used primarily for patients requiring long-term peritoneal dialysis or chemotherapy.
• Goals: To provide a reliable and efficient way to administer treatments directly into the peritoneal cavity.
• Expected Outcomes: Improved management of the underlying condition with a lower risk of infection compared to external catheters.

Indications

• Patients requiring chronic peritoneal dialysis due to kidney failure.
• Individuals needing intraperitoneal chemotherapy for certain cancers.
• Patients with refractory ascites needing frequent drainage.

Preparation

• Pre-Procedure Instructions: Patients may need to fast for a certain period before the procedure, typically 6-8 hours.
• Medication Adjustments: Specific medications, especially blood thinners, may need to be paused.
• Diagnostic Tests: Blood tests, imaging studies (like an ultrasound or CT scan), and a thorough physical exam.

Procedure Description

1. Anesthesia: The patient is given local or general anesthesia.
2. Incision: A small incision is made in the abdominal area.
3. Catheter Placement: The catheter is carefully inserted into the peritoneal cavity.
4. Tunneling: The catheter is tunneled under the skin to a subcutaneous pocket where the port is implanted.
5. Securing the Port: The port is securely placed under the skin surface.
6. Closure: The incisions are closed with sutures or staples.
7. Testing: The system is tested to ensure proper function.

Duration

The procedure typically takes about 1-2 hours.

Setting

Performed in a hospital operating room or surgical center.

Personnel

• Surgeon: Specialized in vascular access or general surgery.
• Nurse: Assists with preparation and monitoring.
• Anesthesiologist: Manages anesthesia and patient comfort.

Risks and Complications

• Common Risks: Infection, bleeding, and catheter dislodgment.
• Rare Complications: Damage to surrounding organs, severe allergic reactions to anesthesia.
• Management: Prompt medical intervention and antibiotics as needed.

Benefits

• Expected Benefits: Reliable access for treatment delivery, reduced infection risk, and improved quality of life.
• Realization Time: Benefits generally realized immediately after the healing period.

Recovery

• Post-Procedure Care: Wound care, keeping the site clean and dry.
• Recovery Time: Typically takes about 1-2 weeks.
• Follow-Up: Regular check-ups to ensure the port is functioning properly.

Alternatives

• Other Options: External catheters, oral or intravenous medications, alternative dialysis methods.
• Pros and Cons: External catheters may have a higher infection risk; oral/IV medications may not be as effective for certain conditions.

Patient Experience

• During Procedure: Minimal discomfort due to anesthesia.
• After Procedure: Possible soreness at the incision site, which can be managed with pain medications.
• Comfort Measures: Pain management regimen and advice on how to care for the port site at home.