36578 Replacement, catheter only, of central venous access device, with subcutaneous port or pump, central or peripheral insertion site

Name of the Procedure:

Replacement, catheter only, of central venous access device, with subcutaneous port or pump, central or peripheral insertion site

Summary

This procedure involves the replacement of the catheter component of a central venous access device that has a subcutaneous port or pump. This type of device is used to deliver medications or nutrients directly into a patient's bloodstream via a large vein. The procedure can be performed on either a central or peripheral insertion site.

Purpose

The main goal of this procedure is to ensure the reliable delivery of medications, nutrients, or other fluids directly into the bloodstream. It is typically done when the existing catheter needs to be replaced due to blockage, infection, or wear.

Indications

• Malfunctioning or blocked catheter
• Infection at the catheter site
• Wear and tear of the catheter
• Regular maintenance as part of long-term central venous access device care

Patients who have conditions requiring long-term intravenous access, such as cancer, severe infections, or nutritional deficiencies, may need this procedure.

Preparation

• Patients may need to fast for a few hours before the procedure.
• Adjustments to medications (e.g., blood thinners) may be required.
• Diagnostic tests, such as blood work or imaging, may be performed to assess the patient's health and the condition of the existing device.

Procedure Description

1. The patient is positioned comfortably, and the skin is cleaned with antiseptic.
2. Local anesthesia is administered to numb the insertion site.
3. The existing catheter is carefully removed.
4. A new catheter is threaded into the vein through the same or a new insertion site.
5. The new catheter is connected to the subcutaneous port or pump.
6. Proper placement is confirmed using imaging techniques like X-ray or ultrasound.
7. The insertion site is closed and dressed to prevent infection.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

This procedure is usually performed in a hospital, outpatient clinic, or a surgical center.

Personnel

• Interventional Radiologist or Vascular Surgeon
• Registered Nurse
• Anesthesiologist (if sedation or general anesthesia is used)
• Radiologic Technologist (if imaging is required)

Risks and Complications

• Infection at the insertion site or in the bloodstream
• Bleeding or hematoma formation
• Catheter misplacement or migration
• Damage to the vein or surrounding tissues
• Allergic reaction to anesthesia or antiseptics
• Rare risk of air embolism

Complications are managed according to their nature, such as antibiotics for infection or repositioning of a misplaced catheter.

Benefits

• Improved function and longevity of the central venous access device
• Continued reliable access for medication, nutrition, or fluid delivery
• Reduced risk of complications from a malfunctioning catheter

The benefits are typically realized immediately following successful replacement.

Recovery

• Post-procedure monitoring for a few hours to ensure there are no immediate complications.
• Instructions on how to care for the insertion site, including keeping it clean and dry.
• Patients may experience mild discomfort, for which over-the-counter pain relievers can be used.
• Return to normal activities expected within a day or two, with specific instructions depending on individual cases.
• Follow-up appointments to check on the new catheter and device functioning.

Alternatives

• Conservative management, if the catheter issue is minor and can be resolved without replacement.
• External central catheters as a temporary solution.
• Peripheral IV lines for short-term access.

The suitability of alternatives depends on the patient's condition; they may have limitations compared to a central venous access device with a subcutaneous port or pump.

Patient Experience

• The patient might feel slight pressure or tugging during the procedure.
• Post-procedure discomfort around the insertion site is common but manageable with pain relief medications.
• The patient may feel tired or a bit sore but should recover quickly with proper care and monitoring.