36557 Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; younger than 5 years of age

Name of the Procedure:

Insertion of Tunneled Centrally Inserted Central Venous Catheter, Without Subcutaneous Port or Pump; Younger than 5 Years of Age

Summary

This procedure involves placing a long, flexible tube (catheter) into a large vein in a young child, typically under 5 years old. The catheter provides a way to deliver medications, nutrients, or fluids directly into the bloodstream over an extended period.

Purpose

This procedure addresses the need for long-term intravenous (IV) access in young children, often used for administering chemotherapy, intravenous nutrition, or long-term antibiotics. The goal is to provide reliable and durable venous access that reduces the need for repeated needle pricks.

Indications

• Need for long-term IV therapy
• Frequent blood sampling
• Administration of medications that can damage smaller peripheral veins
• Conditions such as cancer, severe infections, or gastrointestinal disorders

Preparation

• Fasting for several hours before the procedure, as directed by the physician
• Adjustments to medications as advised
• Pre-procedure blood tests and imaging studies

Procedure Description

1. The child is given anesthesia to ensure they are asleep and feel no pain.
2. A small incision is made near the collarbone.
3. The catheter is inserted into a large vein and tunneled under the skin to a separate exit site.
4. The catheter is threaded through the vein until it reaches a large central vein near the heart.
5. The incision is closed and dressed to prevent infection.

Tools used: Catheter, tunneling device, sterile drapes, and surgical instruments

Anesthesia: General anesthesia

Duration

The procedure typically takes about 1 to 2 hours.

Setting

This procedure is performed in a hospital operating room.

Personnel

• Pediatric surgeon or interventional radiologist
• Anesthesiologist
• Surgical nurses
• Technicians

Risks and Complications

• Infection at the insertion site
• Bleeding or bruising
• Accidental dislodgement of the catheter
• Blood clot formation
• Damage to nearby blood vessels or organs

Benefits

• Reliable long-term IV access
• Fewer needle sticks for the child
• Ability to receive essential treatments or nutrients

Recovery

• Monitoring in the recovery room for a few hours post-procedure
• Instructions for keeping the insertion site clean and dry
• Pain management with prescribed medications
• Follow-up appointments to check catheter function and site healing

Expected recovery time: Few days to a week

Alternatives

• Peripheral IV lines (short-term and less durable)
• Peripherally inserted central catheter (PICC)
• Subcutaneous ports (involve surgical placement and may not be suitable for very young children)

Pros and Cons: Alternatives may be less invasive but are often less durable or effective for long-term use.

Patient Experience

During the procedure, the child will be under anesthesia and will not feel anything. After the procedure, there may be some tenderness or mild pain at the insertion site. Pain management and comfort measures will be provided.