36582 Replacement, complete, of a tunneled centrally inserted central venous access device, with subcutaneous port, through same venous access

Name of the Procedure:

Replacement, complete, of a tunneled centrally inserted central venous access device, with subcutaneous port, through same venous access.
Common names: Central Line Replacement, Port Replacement.

Summary

A central line replacement involves taking out the existing central venous access device and replacing it with a new one through the same venous pathway. The procedure is essential for maintaining reliable and durable intravenous access, often using a subcutaneous port for ease of access and reduced infection risk.

Purpose

This procedure addresses issues such as malfunction, infection, or wear of the existing central venous access device. The goals are to provide a reliable, long-term intravenous access point for administering medications, fluids, or for blood draws.

Indications

• Catheter malfunction or blockage
• Infection at the catheter site
• Wear or damage to the existing device
• Requirement for long-term intravenous therapy in patients with difficult venous access

Preparation

• Fasting for 6-8 hours prior to the procedure if instructed
• Adjustments to current medications as directed by the healthcare provider
• Pre-procedure blood tests to check clotting status and overall health
• Imaging studies such as an ultrasound or chest X-ray to assess venous access

Procedure Description

1. The patient is positioned for optimal access to the central venous device.
2. A local anesthetic is administered to numb the area. Sedation or general anesthesia may be used depending on patient needs.
3. The existing device is carefully removed through the same venous pathway.
4. The new central venous access device with a subcutaneous port is inserted and properly positioned using imaging guidance.
5. The position is confirmed, and the device is secured in place.
6. The site is cleaned and dressed to prevent infection.

Duration

The procedure typically takes between 1 to 2 hours.

Setting

The procedure is usually performed in a hospital's interventional radiology suite or a surgical center.

Personnel

• Interventional Radiologist or Surgeon
• Nurses
• Anesthesiologist (if sedation or general anesthesia is required)
• Radiology Technologist (for imaging support)

Risks and Complications

• Infection at the insertion site
• Bleeding or hematoma formation
• Pneumothorax (air in the chest cavity)
• Catheter malposition or displacement
• Thrombosis (blood clot formation)
• Allergic reaction to anesthetic or materials used

Benefits

• Restored reliable central venous access
• Reduced risk of infection with a new, properly functioning device
• Improved patient comfort and care efficiency

Recovery

• Monitoring in a recovery area until anesthesia or sedation effects wear off
• Keeping the dressing clean and dry as per instructions
• Follow-up appointments to check the insertion site and device function
• Avoid heavy lifting and strenuous activities for a few days post-procedure

Alternatives

• Placement of a new central line at a different site
• Use of peripheral IV lines (short-term solution)
• Peripherally Inserted Central Catheter (PICC line) as an alternative for certain patients

Patient Experience

During the procedure, the patient may feel pressure but minimal pain due to the anesthetic. Post-procedure, there may be some soreness or discomfort at the insertion site, which can be managed with prescribed pain medication. The patient will need to closely follow aftercare instructions to ensure proper healing and device functionality.