Name of the Procedure:

Removal of Tunneled Central Venous Access Device, with Subcutaneous Port or Pump, Central or Peripheral Insertion

Summary

The removal of a tunneled central venous access device involves taking out a special type of catheter that has been inserted into a large vein, usually to deliver medication, nutrients, or for dialysis. This device often includes a subcutaneous (under the skin) port or pump.

Purpose

This procedure is performed when the device is no longer needed, if it has become infected, if it is malfunctioning, or if the patient has completed the treatment that required the device. The primary goal is to safely and effectively remove the catheter and port to prevent complications such as infection or thrombosis.

Indications

• Completion of treatment (e.g., chemotherapy, long-term antibiotic therapy)
• Infection at the device site
• Device malfunction or blockage
• Pain or discomfort at the insertion site
• Patient request for device removal

Preparation

• Patients may need to fast for several hours if general anesthesia is used.
• Blood tests and imaging may be required to assess the position and condition of the device.
• Patients should inform the medical team of any medications they are taking and may need to adjust anticoagulants or other specific drugs before the procedure.

Procedure Description

1. The patient is positioned comfortably, and the procedure area is sterilized.
2. Local anesthesia or sedation is administered to minimize discomfort.
3. An incision is made over the site of the port or pump.
4. The catheter is carefully detached from the vein and any anchoring sutures are removed.
5. The port or pump is removed, and the incision is closed with sutures or surgical staples.
6. The wound is dressed to keep it clean and facilitate healing.

Duration

The procedure typically takes 30 minutes to an hour.

Setting

The procedure is usually performed in a hospital, outpatient clinic, or a surgical center, depending on the complexity and patient's condition.

Personnel

• Surgeon or Interventional Radiologist
• Nurse
• Anesthesiologist (if general anesthesia is required)
• Surgical Technician

Risks and Complications

• Infection at the removal site
• Bleeding or hematoma formation
• Blood clot (thrombosis)
• Damage to surrounding tissues or blood vessels
• Allergic reaction to anesthesia or medications

Benefits

• Removal of a no longer needed device reduces the risk of infection.
• Immediate relief from device-related pain or discomfort.
• Better quality of life without the need for managing a central line.

Recovery

• Keep the incision clean and dry. Follow specific wound care instructions provided by the healthcare provider.
• Mild pain or discomfort can be managed with prescribed or over-the-counter pain medications.
• Avoid strenuous activities until cleared by the healthcare provider.
• Follow-up appointments to ensure proper healing of the incision site.

Alternatives

Non-surgical management could involve simply monitoring the device if it’s not causing immediate harm. In cases where the device is still needed but malfunctioning, placing a new device at a different site might be considered. Discuss the pros and cons with the healthcare team to understand the best option.

Patient Experience

During the procedure, the patient may feel pressure or pulling sensations but will generally not feel pain due to local anesthesia. Post-procedure, there might be some discomfort or soreness at the site, which can be managed with pain medications. Patients are typically able to return home on the same day and resume normal activities in a few days, with specific instructions provided by their healthcare provider.