Mechanical removal of intraluminal (intracatheter) obstructive material from central venous device through device lumen, radiologic supervision and interpretation
CPT4 code
Name of the Procedure:
Mechanical removal of intraluminal (intracatheter) obstructive material from central venous device through device lumen, radiologic supervision and interpretation.
- Common Name: Central Venous Catheter (CVC) Thrombectomy or Catheter Clearing
Summary
This procedure removes blockages from a central venous catheter (CVC) to restore its proper function. It uses mechanical tools to clear obstructions like blood clots or debris while being guided and monitored using imaging techniques.
Purpose
The procedure addresses blockages in central venous catheters that can impede the delivery of medications, nutrients, or blood products. The primary goal is to restore catheter function and ensure it can be used effectively for treatments.
Indications
- Occluded or poorly functioning central venous catheter
- Symptoms of catheter blockage (e.g., difficulty infusing fluids, absence of blood return)
- Confirmed intraluminal occlusion through diagnostic imaging
Preparation
- Patients may require fasting for a few hours prior to the procedure.
- Medication adjustments may be necessary, especially blood thinners.
- Pre-procedure imaging and blood tests are often conducted to assess the patient’s condition.
Procedure Description
- The patient is positioned and prepped in a sterile environment.
- Local anesthesia is administered at the catheter site for patient comfort.
- A fluoroscope or other imaging device guides the procedure, providing real-time visualization.
- A mechanical thrombectomy tool or specialized catheter is inserted through the device lumen.
- The obstructive material, such as a clot or debris, is mechanically broken up and removed.
- Post-procedure imaging confirms that the catheter is clear and functioning properly.
Duration
The procedure typically takes about 30 to 60 minutes, depending on the complexity of the blockage.
Setting
This procedure is usually performed in a hospital's interventional radiology suite or a specialized outpatient clinic.
Personnel
- Interventional radiologist
- Radiologic technologist
- Nurse
- Possible involvement of an anesthesiologist for sedation
Risks and Complications
- Common risks: Minor bleeding, infection at the insertion site, temporary pain
- Rare risks: Damage to the catheter, vessel injury, allergic reaction to contrast dye, embolism (dislodged debris causing blockage elsewhere)
Benefits
- Restoration of catheter function, allowing continued treatment
- Immediate improvement in the ability to infuse medications and obtain blood samples
- Reduced need for catheter replacement
Recovery
- Post-procedure, patients are monitored for a few hours for any immediate complications.
- Patients can usually resume normal activities within a day.
- Follow-up appointments may be necessary to ensure the catheter remains functional.
Alternatives
- Pharmacological thrombolysis: Using medication to dissolve the clot, though it may take longer and carries bleeding risks.
- Catheter replacement: Involves removing and placing a new catheter, which is more invasive.
Patient Experience
During the procedure, the patient may feel pressure but should not experience significant pain due to local anesthesia. Post-procedure, there might be mild discomfort at the catheter site, manageable with over-the-counter pain relievers.