Name of the Procedure:

Insertion of tunneled centrally inserted central venous access device, requiring 2 catheters via 2 separate venous access sites; without subcutaneous port or pump (e.g., Tesio type catheter)

Summary

This procedure involves inserting two central venous catheters, each through a separate venous access site, to provide long-term access to the central veins. These catheters do not include a subcutaneous port or pump.

Purpose

This procedure addresses the need for long-term intravenous access, which is often required for treatments such as chemotherapy, dialysis, or long-term medication administration. The goal is to provide a stable and reliable means for frequent access to the central veins.

Indications

• Chronic kidney disease requiring dialysis
• Long-term chemotherapy
• Long-term medication or nutritional administration
• Frequent blood sampling
• Conditions necessitating long-term venous access

Patients who require continuous treatment over an extended period and have poor peripheral venous access are particularly suited for this procedure.

Preparation

• Patients may be advised to fast for several hours before the procedure.
• Anticoagulant medications may need to be adjusted.
• Basic blood tests and imaging studies might be required to assess the venous anatomy and ensure proper site selection.

Procedure Description

1. The patient is positioned in a sterile environment with appropriate antiseptic measures applied to the insertion sites.
2. Local anesthesia or mild sedation is administered.
3. Two separate venous access sites are identified and catheter insertion is performed.
4. Using imaging guidance, the catheters are tunneled under the skin to enter the central veins and positioned correctly.
5. The catheters are then secured, and the exit sites are dressed.

Tools: Sterile catheters, imaging equipment (ultrasound or fluoroscopy), surgical instruments. Anesthesia: Local anesthesia or mild sedation.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

The procedure is usually performed in a hospital or a surgical center with imaging capabilities.

Personnel

• Interventional radiologist or vascular surgeon
• Nursing staff
• Anesthesiologist or nurse anesthetist (if sedation is used)

Risks and Complications

• Infection at the insertion site
• Bleeding
• Catheter displacement or malfunction
• Pneumothorax (collapsed lung)
• Blood clots

Complications are managed based on their severity, which may include antibiotics for infections, repositioning or replacing the catheter, or other appropriate therapeutic interventions.

Benefits

• Reliable long-term venous access
• Reduced need for multiple needle sticks
• Convenient for repeated treatments
• Immediate usability after placement

Patients may notice the benefits within days and appreciate the ease of treatment administration.

Recovery

• Post-procedure monitoring for several hours
• Follow-up care instructions on how to care for the catheter sites
• Avoid heavy lifting and strenuous activities for a few days
• Regular follow-ups to monitor the catheter function and site health

Recovery time varies, but patients can often resume normal activities within a few days with some restrictions.

Alternatives

• Peripheral IV catheters (short-term use)
• Implanted ports (longer-term but requires needle access)
• Peripherally inserted central catheters (PICCs)

Each alternative has its own pros and cons, such as duration of use, ease of access, and associated infection risks.

Patient Experience

Patients might experience mild discomfort during the procedure and local tenderness at the insertion sites afterward. Pain management includes over-the-counter pain relievers and prescribed medications if necessary. Proper care and hygiene of the catheter sites are essential for comfort and to prevent complications.