76937 Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting (Lis

Name of the Procedure:

Ultrasound Guidance for Vascular Access (UGVA)

Summary

This procedure uses real-time ultrasound imaging to guide the placement of a needle into a blood vessel. It helps ensure accurate needle entry and optimal placement for intravenous (IV) lines, catheters, or other medical devices.

Purpose

Ultrasound-guided vascular access is performed to ensure safe and precise placement of needles or catheters into blood vessels. It helps to reduce complications and increases the success rate of vascular access procedures.

Indications

• Difficulty in accessing veins due to small, collapsed, or hidden veins
• Requiring placement of central venous catheters, dialysis catheters, or other long-term intravenous lines
• Conditions such as dehydration, obesity, or a history of multiple IV insertions that complicate vascular access

Preparation

• Follow instructions regarding fasting if sedation is planned.
• Inform the healthcare provider about any medications or allergies.
• A physical examination and review of medical history will be conducted.
• No special diagnostic tests are typically required, but previous imaging results may be reviewed if available.

Procedure Description

1. The skin over the chosen access site is cleaned and disinfected.
2. Ultrasound gel is applied to the skin to improve conductivity.
3. The ultrasound probe is used to evaluate and identify a suitable vessel.
4. Once a suitable vessel is found, its patency is documented.
5. Under real-time ultrasound guidance, a needle is inserted into the vessel.
6. The needle's position is continuously monitored on the ultrasound screen.
7. Successful cannulation is confirmed by aspirating blood and/or ultrasound visualization.
8. The procedure is permanently recorded, and a report is generated.

Duration

The procedure typically takes about 15-30 minutes, depending on the difficulty and the number of attempts required.

Setting

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

Personnel

• Radiologist or specially trained physician
• Registered nurse or technologist
• Anesthesia provider if sedation is required

Risks and Complications

• Minor risk of bleeding or bruising at the needle insertion site
• Rare risks include infection, arterio-venous fistula, or damage to adjacent structures
• Complications are managed based on clinical guidelines and might require additional procedures.

Benefits

• Increased success rate of vascular access
• Reduced risk of complications like arterial puncture or hematoma
• Immediate visual confirmation of proper cannulation
• Typically realized immediately or very shortly after the procedure

Recovery

• Minimal recovery time; patients can often resume normal activities quickly.
• Follow any specific post-procedure instructions given by the healthcare provider.
• Keep the access site clean and dry.
• Report any unusual pain, swelling, or signs of infection.

Alternatives

• Traditional palpation technique without ultrasound guidance
• Fluoroscopic or other image-guided techniques
• Each alternative has its own pros and cons, such as less precision without ultrasound or increased radiation exposure with fluoroscopy.

Patient Experience

• The procedure is generally well-tolerated; you may feel mild discomfort from the needle insertion.
• Sedation or local anesthesia can help manage any discomfort.
• Some pressure might be felt during the needle advancement but should not be significantly painful.
• After recovery, normal activities can typically be resumed quickly.