Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain (intraventricular), includes electronic analysis of pump, when performed
CPT4 code
Name of the Procedure:
Refilling and Maintenance of Implantable Pump or Reservoir for Drug Delivery (Spinal [Intrathecal, Epidural] or Brain [Intraventricular]), includes Electronic Analysis of Pump.
Summary
This procedure involves refilling an implantable pump that delivers medication directly to the spinal cord or brain. It includes checking the pump’s electronic functions to ensure it is operating correctly.
Purpose
The procedure is designed to manage chronic pain, spasticity, or other neurological conditions by delivering medication directly to the affected area. The goal is to maintain effective drug delivery, manage symptoms, and monitor the functioning of the implantable pump.
Indications
- Chronic pain
- Muscle spasticity
- Severe dystonia
- Certain types of cancer pain
- Conditions requiring targeted drug delivery directly to spinal or brain tissue
Preparation
- Patients may be advised to fast for a few hours before the procedure.
- Blood tests or imaging studies may be required to assess the pump’s placement and function.
- Adjustments to current medications might be necessary.
Procedure Description
- The patient is positioned comfortably, usually lying prone.
- The area around the pump is cleansed and sterilized.
- A needle is inserted into the pump reservoir to withdraw any remaining medication.
- The reservoir is then refilled with the prescribed medication.
- Electronic analysis is performed to ensure proper pump functions such as battery life and medication delivery settings.
- The injection site is cleaned and bandaged.
Tools used include sterile needles, syringes, antiseptics, and specialized programming devices for the pump. Local anesthesia is typically used to numb the area.
Duration
The procedure usually takes about 30 to 60 minutes.
Setting
This procedure is generally performed in an outpatient clinic or hospital setting.
Personnel
- Pain specialist or neurologist
- Nurse
- Potential involvement of a technician for electronic analysis
Risks and Complications
- Infection at the injection site
- Bleeding
- Pump malfunction
- Allergic reaction to medication
- Drug overdose or underdose
These complications can often be managed with appropriate medical intervention.
Benefits
Expected benefits include effective pain or symptom management and improved quality of life, often noticeable within days after the procedure.
Recovery
- Patients can typically return home the same day.
- Minor discomfort or bruising at the injection site is common.
- Follow-up appointments are necessary to monitor pump function and symptom control.
- Activity restrictions may apply for a short period.
Alternatives
- Oral or systemic medication
- External pumps or transdermal patches
- Surgical interventions The suitability and effectiveness of alternatives vary based on individual conditions and medical history.
Patient Experience
During the procedure, patients may feel slight pressure or discomfort at the injection site. Local anesthesia minimizes pain during the refill. Post-procedure, there might be mild soreness or bruising, manageable with over-the-counter pain relief.