36595 Mechanical removal of pericatheter obstructive material (eg, fibrin sheath) from central venous device via separate venous access

Name of the Procedure:

Mechanical removal of pericatheter obstructive material (e.g., fibrin sheath) from central venous device via separate venous access.

Summary

This procedure involves the mechanical removal of materials that obstruct a central venous catheter (CVC), such as fibrin sheaths, using a different venous access point. This helps restore the proper functioning of the catheter.

Purpose

The procedure addresses blockages in central venous catheters caused by materials like fibrin sheaths, which can interfere with the catheter's ability to deliver medications or withdraw blood. The goal is to clear the obstruction, improving catheter function and ensuring effective treatment.

Indications

• Inability to withdraw blood from the central venous catheter.
• Difficulty or resistance when infusing medications or fluids.
• Long-term central venous access issues.
• Patients with persistent catheter malfunction despite conservative management.

Preparation

• Patients may be asked to fast for several hours before the procedure.
• Blood tests, such as clotting profiles, to ensure safe procedure conditions.
• Patients should inform their healthcare provider of any medications they are taking, especially blood thinners.

Procedure Description

1. The patient is positioned appropriately and an alternative venous access site is prepared.
2. Local anesthesia is administered to numb the area.
3. A guidewire and catheter are inserted into the separate venous access point.
4. Mechanical tools or devices, such as snares or sheaths, are guided to the obstructed central venous catheter.
5. The obstructive material is mechanically disrupted and removed.
6. The patency of the central venous catheter is confirmed through aspiration and infusions.
7. The alternative venous access is closed and dressed.

Tools used may include guidewires, mechanical snares, and sheaths. Local anesthesia is commonly used; sedation may be provided if necessary.

Duration

The procedure typically takes between 30 to 60 minutes.

Setting

This procedure is performed in a hospital, usually within a radiology suite or an operating room equipped with imaging capabilities.

Personnel

• Interventional radiologists or vascular surgeons.
• Nurses specialized in interventional procedures.
• Anesthesiologists or nurse anesthetists, if sedation is required.

Risks and Complications

Common Risks:

• Bleeding or hematoma formation.
• Infection at the access site.

Rare Risks:

• Injury to nearby blood vessels.
• Air embolism.
• Thrombosis or clot formation.

Benefits

The primary benefit is the restoration of the central venous catheter function, allowing for effective delivery of medications and fluids, and the ability to draw blood samples as required. Benefits are typically realized immediately after the procedure.

Recovery

• Patients are monitored for a few hours post-procedure.
• They may be advised to avoid strenuous activities for 24-48 hours.
• Instructions on catheter care and follow-up appointments will be provided.

Alternatives

• Thrombolytic therapy to dissolve the obstructive material.
• Catheter exchange or removal.
• Pros of alternatives: Less invasive (thrombolytic).
• Cons of alternatives: May not be effective for all types of obstructions.

Patient Experience

During the procedure, patients may feel slight pressure or discomfort at the access site due to anesthesia. Post-procedure, some soreness at the access site is expected. Pain management may include over-the-counter pain relievers and rest.