36563 Insertion of tunneled centrally inserted central venous access device with subcutaneous pump

Name of the Procedure:

Insertion of Tunneled Centrally Inserted Central Venous Access Device with Subcutaneous Pump
Common Names: Tunneled Central Line, Central Venous Catheter with Subcutaneous Pump, Hickman Catheter (brand name)

Summary

In layman's terms, this procedure involves placing a specialized tube (catheter) into a large vein, usually in the chest, to provide long-term access for medications, nutrients, or blood products. A small pump is placed under the skin to control the flow of these substances.

Purpose

This procedure is primarily used for patients who need long-term intravenous (IV) therapy, including chemotherapy, antibiotic therapy, or parenteral nutrition. The goal is to allow easy and reliable access to the bloodstream while minimizing discomfort and reducing the risk of infection.

Indications

• Long-term chemotherapy
• Long-term antibiotic or antifungal treatment
• Total parenteral nutrition (TPN)
• Frequent blood draws or blood transfusions
• Conditions such as cancer, severe infections, or gastrointestinal disorders requiring prolonged IV access

Preparation

• Patients may be instructed to fast for several hours before the procedure.
• Adjustments to medications may be needed; patients should discuss current medications with their healthcare provider.
• Pre-procedure diagnostic tests might include blood work and imaging studies (e.g., ultrasound, chest X-ray).

Procedure Description

1. The patient is placed under local anesthesia and sedation.
2. A small incision is made near the vein, typically in the chest area.
3. A catheter is tunneled under the skin and inserted into a large vein.
4. The catheter is advanced to a central vein, often near the heart.
5. A small subcutaneous pump is placed under the skin to regulate the flow of medications.
6. The site is closed with sutures or surgical glue, and a sterile dressing is applied.

Tools and Equipment:

• Catheter (e.g., Hickman catheter)
• Subcutaneous pump
• Sterile surgical instruments
• Ultrasound and X-ray equipment for guidance

Duration

The procedure typically takes about 1 to 2 hours.

Setting

Performed in a hospital operating room or specialized outpatient surgical center.

Personnel

• Surgeon or Interventional Radiologist
• Anesthesiologist
• Nurses
• Surgical Technologist or Assistant

Risks and Complications

• Infection at the insertion site or along the catheter path
• Bleeding or hematoma formation
• Pneumothorax (collapsed lung)
• Thrombosis (blood clots)
• Catheter malfunction or dislodgement
• Allergic reaction to anesthesia or materials

Benefits

• Provides reliable and convenient long-term IV access
• Reduces the need for repeated needle sticks and venipunctures
• Helps deliver treatments more effectively
• Can improve patient comfort and quality of life

Recovery

• Patients may need to stay for a short observation period after the procedure.
• Instructions will be provided for care of the insertion site, including keeping it clean and dry.
• Activity restrictions might be necessary for a few days.
• Regular follow-up appointments are important to monitor the device and manage any complications.

Alternatives

• Peripherally Inserted Central Catheter (PICC line)
• Port-a-Cath (implanted port)

• Peripheral IV lines (for short-term use)

  Pros and Cons:

• PICC lines are less invasive but generally less durable and convenient for long-term use.
• Port-a-Cath may offer a less visible option but requires a more complex implantation procedure and maintenance.

Patient Experience

During the procedure, the patient should expect to feel minimal pain due to local anesthesia and sedation. Some discomfort or pressure may be felt at the incision site. Post-procedure, mild soreness and bruising at the insertion site are common, and pain management options will be provided as needed.