36148 Introduction of needle and/or catheter, arteriovenous shunt created for dialysis (graft/fistula); additional access for therapeutic intervention (List separately in addition to code for primary procedure)

Name of the Procedure:

Introduction of needle and/or catheter, arteriovenous shunt created for dialysis (graft/fistula); additional access for therapeutic intervention.

Summary

This procedure involves inserting a needle or catheter into an existing arteriovenous (AV) shunt, such as a graft or fistula, which is used for dialysis. This is done to create an additional access point for therapeutic interventions.

Purpose

The procedure is performed to manage chronic kidney disease in patients requiring dialysis. It allows for additional access to an AV shunt so that life-saving treatments can be administered. The goal is to ensure patients have consistent and reliable vascular access for dialysis.

Indications

• Central venous stenosis or thrombosis limiting access.
• Clotted AV fistula or graft requiring immediate intervention.
• Need for additional access due to high dialysis flow demand.
• Inadequate blood flow through the primary access.

Preparation

• Patients may need to fast for a few hours before the procedure.
• Review current medications and adjust as necessary, often including blood thinners.
• Pre-procedure blood tests and imaging studies like an ultrasound or angiography may be required.

Procedure Description

1. The patient is positioned comfortably, typically on an examination table.
2. The skin over the existing AV shunt is cleaned and sterilized.
3. Local anesthesia is administered to numb the area.
4. A needle or catheter is carefully introduced into the shunt.
5. If needed, imaging guidance (such as ultrasound or fluoroscopy) is used to ensure correct placement.
6. The additional access is secured and tested for functionality.
7. The site is dressed with sterile bandages.

Duration

The procedure typically takes about 30 minutes to 1 hour.

Setting

The procedure is usually performed in a hospital, outpatient clinic, or surgical center equipped for minor interventions.

Personnel

• Interventional Radiologist or Vascular Surgeon
• Nurses
• Possibly an Anesthesiologist, depending on patient needs

Risks and Complications

• Infection at the insertion site
• Bleeding or hematoma formation
• Injury to blood vessels or surrounding tissues
• Clot formation within the shunt
• Need for additional interventions if complications arise

Benefits

• Provides reliable vascular access for effective dialysis treatments.
• Enhances the life span of existing AV shunt.
• Reduces the need for central venous catheters, minimizing associated risks.

Recovery

• Patients can usually go home the same day.
• Follow care instructions provided by the healthcare team, including keeping the site clean and dry.
• Monitor for signs of infection or complications.
• Follow-up appointments may be scheduled to ensure the access remains functional.

Alternatives

• Use of tunneled central venous catheters for temporary access.
• Creation of a new AV fistula or graft at a different site.
• Peritoneal dialysis, an alternative to hemodialysis. Each alternative has its pros and cons, such as varying risks of infection, effectiveness, and suitability based on individual patient factors.

Patient Experience

• Mild discomfort from the local anesthesia injection and the needle/catheter insertion.
• Post-procedure soreness or bruising at the access site.
• Pain is generally manageable with over-the-counter pain relievers as advised by the healthcare provider.
• Instructions will be given to keep the site clean and avoid strenuous activities that may stress the new access point.