Insertion of tunneled intraperitoneal catheter for dialysis, open
CPT4 code
Name of the Procedure:
Insertion of Tunneled Intraperitoneal Catheter for Dialysis, Open
Common Name(s): Surgically-placed peritoneal dialysis catheter, Tenckhoff catheter insertion
Summary
This procedure involves surgically placing a special catheter into the abdomen to allow for peritoneal dialysis, which is a method to remove waste products and excess fluid when the kidneys can no longer perform these functions adequately.
Purpose
Medical Condition/Problem: Chronic kidney disease or kidney failure. Goals/Expected Outcomes: To provide a reliable access point for peritoneal dialysis, enabling regular dialysis treatments to manage kidney failure.
Indications
- End-stage renal disease (ESRD)
- Chronic kidney disease requiring dialysis
- Patients who prefer or are medically suited for peritoneal dialysis over hemodialysis
Preparation
- The patient may need to fast for several hours before the procedure.
- Certain medications, especially blood thinners, may need to be adjusted.
- Preoperative blood tests, imaging studies, and evaluation of overall health status are typically required.
Procedure Description
- The patient is placed under general or local anesthesia.
- An incision is made in the abdominal wall.
- A tunnel is created under the skin from the incision site to the peritoneal cavity.
- The catheter is inserted through this tunnel and secured in place.
- The other end of the catheter, which remains outside the body, is connected to dialysis equipment.
- The incision is closed, and the area is dressed.
Tools and Equipment: Scalpel, tunneling device, peritoneal catheter, sutures, and dialysis connection equipment.
Anesthesia/Sedation: Local or general anesthesia, depending on patient and surgeon preference.
Duration
The procedure typically takes about 1 to 2 hours.
Setting
This procedure is performed in a hospital operating room or a specialized surgical center.
Personnel
- Surgeon specialized in dialysis access
- Anesthesiologist or nurse anesthetist (if general anesthesia is used)
- Operating room nurses and surgical technicians
Risks and Complications
- Common Risks: Infection, bleeding, catheter malfunction or displacement
- Rare Risks: Injury to abdominal organs, peritonitis, anesthesia-related complications
- Management: Monitoring and antibiotics for infections, surgical revision for catheter issues
Benefits
- Expected Benefits: Effective and reliable access for peritoneal dialysis
- Timeline: Functionality of the catheter typically established within days to weeks post-insertion
Recovery
- Post-procedure monitoring for complications
- Keeping the surgical site clean and dry
- Gradual resumption of normal activities as advised by the healthcare provider
- Follow-up appointments to ensure proper healing and catheter function
Recovery Time: Full recovery may take a few weeks, with care instructions provided for managing the catheter.
Alternatives
- Other Options: Hemodialysis (using a hemodialysis machine and vascular access)
- Pros and Cons: Hemodialysis requires regular visits to a dialysis center and vascular access, which may be less convenient but suitable for those unable to undergo peritoneal dialysis.
Patient Experience
- During Procedure: Patient may feel nothing if under general anesthesia; if local anesthesia is used, there may be some pressure or pulling sensations.
- After Procedure: Expected soreness at the incision site, temporary limitations on physical activity, and instructions for catheter care.
- Pain Management: Pain medications and antibiotics may be prescribed to manage discomfort and prevent infection.