62355 Removal of previously implanted intrathecal or epidural catheter

Name of the Procedure:

Removal of previously implanted intrathecal or epidural catheter

Summary

This procedure involves the surgical removal of a catheter that was previously implanted in the intrathecal (in the space around the spinal cord) or epidural (in the space outside the dura mater of the spinal cord) space. The catheter is often used for long-term pain management or delivery of medications directly to the spinal region.

Purpose

The purpose of the procedure is to address issues such as infection, catheter malfunction, patient discomfort, or the end of the treatment plan. The goal is to safely remove the catheter while ensuring the patient's comfort and preventing complications.

Indications

• Infection at the catheter site
• Malfunction or blockage in the catheter
• Persistent pain or discomfort due to the catheter
• Completion of treatment requiring the catheter
• Catheter-associated complications like spinal fluid leakage or hematoma

Preparation

• Pre-procedure instructions may include fasting for a certain period.
• Adjustments in regular medications, especially blood thinners, may be needed.
• Diagnostic tests such as MRI or X-rays might be conducted to assess the catheter position.

Procedure Description

1. The patient is positioned appropriately, usually lying face down or on their side.
2. The procedure area is sterilized and local anesthesia is administered.
3. An incision is made at the site where the catheter was implanted.
4. The catheter is carefully extracted from the spinal region.
5. The incision is closed with sutures or surgical glue.
6. The area is dressed to promote healing and prevent infection.

Tools and Equipment Used:

• Scalpel
• Sterile gloves and drapes
• Suture or surgical glue
• Local anesthetic

Anesthesia Details:

• Local anesthesia is typically used. Sedation may be administered based on patient anxiety levels or complexity of the procedure.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

This procedure is most commonly performed in a hospital, outpatient clinic, or surgical center.

Personnel

• Surgeon or pain management specialist
• Nurses for assistance and patient care
• Anesthesiologist if sedation or general anesthesia is required

Risks and Complications

• Infection at the site of removal
• Bleeding or hematoma
• Spinal fluid leakage
• Nerve damage, though rare
• Incomplete catheter removal requiring additional surgery

Benefits

• Resolution of infection or catheter-related complications
• Relief from discomfort or pain caused by the catheter
• Restoration of patient mobility and comfort
• Expectation of improved quality of life soon after recovery

Recovery

• Post-procedure care includes monitoring the site for signs of infection.
• Pain management with medications as needed.
• Follow-up appointments to check healing progress and suture removal.
• Expected recovery time is about 1-2 weeks with minimal restrictions.

Alternatives

• Conservative management like antibiotic therapy for mild infections.
• Imaging-guided interventions for catheter repositioning rather than removal.
• Benefits of the described procedure typically outweigh risks if indicated.

Patient Experience

• Mild discomfort during local anesthesia injection.
• Tingling or slight pulling sensation during catheter removal.
• Post-procedure soreness managed with pain medications.
• General advice includes rest, proper wound care, and avoiding strenuous activities during recovery.