Replacement, complete, of a peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, through same venous access, including all imaging guidance, image documentation, and all associated radiological supervision and interpret
CPT4 code
Name of the Procedure:
Replacement, complete, of a peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, through the same venous access, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation.
Summary
In this procedure, an existing PICC line is completely removed and replaced with a new one using the same entry point in the vein. Imaging technology is used to guide the insertion and ensure proper placement of the new catheter.
Purpose
This procedure is performed to address problems like infection, blockage, or damage in the existing PICC line. The goal is to restore safe and effective central venous access for treatments such as long-term medication administration, nutrition, or frequent blood draws.
Indications
- Infection at the PICC site or within the catheter.
- Blockage or clot in the existing PICC line.
- Damage or malfunction of the PICC.
- Need for a long-term intravenous access in patients with difficult vein access.
Preparation
- Patients may need to undergo blood tests or imaging studies to assess the venous access site.
- Instructions to avoid eating or drinking for several hours before the procedure might be given.
- Medication review, with possible adjustments to anticoagulants or other drugs.
Procedure Description
- The patient is positioned comfortably and the existing PICC line is assessed.
- An antiseptic solution is applied to the insertion site to minimize infection risk.
- Local anesthesia is administered to numb the area.
- The existing PICC line is carefully removed.
- A guide wire may be used to keep the vein open, and imaging guidance (e.g., ultrasound, fluoroscopy) is utilized.
- The new PICC line is inserted through the same venous access point.
- Placement is confirmed using imaging technology to ensure it is correctly positioned near the heart.
- The insertion site is cleaned and a sterile dressing is applied.
Duration
The procedure typically takes about 1 to 2 hours, including preparation time.
Setting
This procedure is typically performed in a hospital's radiology or interventional suite.
Personnel
- Interventional radiologist or specially trained physician
- Nurses to assist with preparation and monitoring
- Radiology technicians to operate imaging equipment
Risks and Complications
- Infection at the insertion site
- Bleeding or bruising
- Injury to the vein or surrounding structures
- Blood clot (thrombosis) near the insertion site
- Catheter misplacement or migration
Benefits
- Restores a functional and stable venous access for necessary treatments
- Reduces the risk of complications such as infection or clotting associated with a damaged or infected PICC line
- Immediate improvement in the ability to administer medications or nutritional support
Recovery
- Patients can typically go home the same day unless otherwise advised.
- Keep the insertion site clean and dry.
- Follow instructions for PICC line care, including flushing the catheter as directed.
- Monitor the site for signs of infection or complications, and follow up with healthcare provider as scheduled.
Alternatives
- Peripheral intravenous (IV) access: Suitable for short-term treatments but less stable for long-term use.
- Central venous catheter (CVC) insertion at a different site: Another option but may require more extensive procedures.
Patient Experience
- Patients may feel a slight pinch or pressure during the administration of local anesthesia.
- Most patients report minimal discomfort during the procedure due to the anesthesia and careful technique.
- Mild soreness or bruising at the insertion site may be experienced afterwards.
- Pain management strategies, including over-the-counter pain relievers, may be recommended based on individual needs.