62365 Removal of subcutaneous reservoir or pump, previously implanted for intrathecal or epidural infusion

Name of the Procedure:

Removal of subcutaneous reservoir or pump, previously implanted for intrathecal or epidural infusion

Summary

This procedure involves the surgical removal of a previously implanted device—either a subcutaneous reservoir or pump—that was used to deliver medication directly into the intrathecal (space around the spinal cord) or epidural space (outer part of the spinal cord).

Purpose

The procedure aims to address issues such as infection, device malfunction, end of therapy, or complications arising from the implanted device. It removes the source of potential problems and may pave the way for an alternative treatment method.

Indications

• Infection or inflammation at the implant site
• Device malfunction or failure
• End of treatment period
• Complications like tissue erosion or migration of the device
• Patient discomfort or pain due to the implant

Preparation

• Fasting for at least 6 hours prior to the procedure
• Reviewing and adjusting medications, especially blood thinners
• Pre-operative tests like blood work and imaging studies to assess the position of the device

Procedure Description

1. The patient is positioned properly and local, regional, or general anesthesia is administered.
2. An incision is made over the site of the implant.
3. The device is carefully located and disconnected from any attached catheters or lines.
4. The implant is gently removed from the subcutaneous tissue.
5. The site is cleaned, and the incision is closed with sutures or staples.
6. A sterile dressing is applied.

Tools used include surgical scalpels, forceps, and sometimes imaging guidance. Anesthesia type depends on patient needs and specific circumstances.

Duration

The procedure typically takes 1-2 hours.

Setting

This procedure is usually performed in a hospital's surgical center or an outpatient surgical facility.

Personnel

• Surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurse(s)
• Surgical technologist

Risks and Complications

• Infection
• Bleeding or hematoma
• Damage to surrounding tissues or nerves
• Pain or discomfort at the incision site
• Scar formation

Benefits

• Removal of the device reduces risks of further complications or infections.
• Alleviates symptoms caused by malfunctioning or problematic implants.
• Typically immediate physical relief and better quality of life are expected.

Recovery

• Keep the surgical site clean and dry as per instructions.
• Follow prescribed pain management.
• Expect mild to moderate discomfort at the site for a few days.
• Generally, recovery takes about 1-2 weeks.
• Follow-up appointment to assess healing.

Alternatives

• Repositioning or replacing the existing device.
• Alternative pain management techniques like oral medications or nerve blocks.
• Non-surgical methods depending on the underlying condition.

Patient Experience

During the procedure, the patient will not feel any pain due to anesthesia. Post-procedure, expect mild to moderate pain, managed by prescribed medications. The site might be sore and swollen initially, improving over the days following the procedure.