49436 Delayed creation of exit site from embedded subcutaneous segment of intraperitoneal cannula or catheter

Name of the Procedure:

Delayed Creation of Exit Site from Embedded Subcutaneous Segment of Intraperitoneal Cannula or Catheter

Summary

In this procedure, an exit site is created from an intraperitoneal catheter or cannula that has been previously embedded under the skin but not yet used. This involves bringing the catheter or cannula to the surface of the skin to allow for future access.

Purpose

This procedure addresses the need for a reliable and functional external access point to an intraperitoneal catheter or cannula, which is typically used for treatments such as peritoneal dialysis. The goal is to create a well-healed exit site to minimize infection risk and facilitate uncomplicated use.

Indications

• Patients requiring peritoneal dialysis.
• Situations where the initial catheter was embedded to allow for tissue healing before use.
• Previous complications that necessitated delayed exit site creation.

Preparation

• Patients may need to fast for a period before the procedure.
• Adjustments to regular medications as advised by the healthcare provider.
• Pre-procedure blood tests and possibly imaging studies.
• Skin cleaning and possibly shaving of the targeted area.

Procedure Description

1. The patient is positioned comfortably, usually in a lying position.
2. Local anesthesia is administered to numb the area where the exit site will be created.
3. The catheter or cannula, which is already embedded under the skin, is carefully located.
4. A small incision is made at the planned exit site.
5. The catheter or cannula is pulled through this incision to create the new exit site.
6. The area around the exit site is cleaned and secured with dressings to promote healing and minimize infection.

Duration

The procedure typically takes about 30 minutes to 1 hour.

Setting

The procedure is usually performed in an outpatient clinic, surgical center, or a hospital setting.

Personnel

• A surgeon or interventional radiologist.
• Nurses for assistance and patient care.
• Possibly an anesthesiologist or a nurse anesthetist for the local anesthesia.

Risks and Complications

• Infection at the site of the incision.
• Bleeding or hematoma formation.
• Pain or discomfort at the exit site.
• Potential for catheter misplacement or functional issues.

Benefits

• Provides a functional access point for intraperitoneal treatments.
• Reduces the risk of infection with a well-healed exit site.
• Generally quick recovery and minimal invasive technique.

Recovery

• Patients typically can go home the same day.
• Instructions for site care to keep it clean and dry.
• Possible mild pain management with over-the-counter medications.
• Follow-up appointments to ensure proper healing and functioning.

Alternatives

• Immediate creation of the exit site during initial catheter placement.
• Using a different type of access, such as a central venous catheter.
• Evaluation of the risk/benefit ratio with other dialysis methods.

Patient Experience

During the procedure, patients will feel minimal pain due to local anesthesia. Post-procedure, patients might experience mild discomfort or soreness at the exit site. Pain is usually manageable with simple analgesics, and detailed care instructions will be provided to maintain the exit site's cleanliness and promote healing.