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Contrast injection(s) for radiologic evaluation of existing central venous access device, including fluoroscopy, image documentation and report

CPT4 code

Name of the Procedure:

Contrast Injection(s) for Radiologic Evaluation of Existing Central Venous Access Device (Fluoroscopy-Guided Central Venous Catheter Study)

Summary

This procedure involves injecting a contrast dye through an existing central venous access device to take detailed X-ray images using fluoroscopy. The contrast dye helps visualize the catheter pathway and ensure it is functioning correctly. The procedure includes image documentation and preparation of a medical report.

Purpose

The procedure is designed to assess the position and function of an existing central venous access device, such as a central line or port. The main goals are to ensure the device is correctly positioned, to verify that it is not blocked or displaced, and to identify any complications such as catheter-related infections or thrombosis.

Indications

  • Unexplained fever in patients with a central venous catheter
  • Suspected line displacement or malfunction
  • Difficulty in drawing blood or infusing medications through the catheter
  • Routine evaluation of the device's placement, especially in long-term central venous access

Preparation

  • Patients may need to fast for a few hours prior to the procedure.
  • Certain medications, especially anticoagulants, may need to be adjusted.
  • Basic diagnostic tests like blood work may be required beforehand.
  • Patients should inform their doctor of any allergies, particularly to contrast dye.

Procedure Description

  1. The patient is positioned appropriately under the fluoroscopy machine.
  2. The skin around the central line access point is cleaned and sterilized.
  3. A small amount of contrast dye is slowly injected through the central venous catheter.
  4. Using fluoroscopy, real-time X-ray images are taken to track the flow of the dye and visualize the position of the catheter.
  5. Images are documented for analysis, and a detailed report is prepared by the radiologist.
  6. The central line is flushed with saline to clear any residual dye.

Duration

The procedure typically takes about 30 minutes to 1 hour.

Setting

The procedure is performed in a radiology suite within a hospital or outpatient imaging center.

Personnel

  • Radiologist (physician specializing in imaging)
  • Radiology technician
  • Nurse or medical assistant

Risks and Complications

  • Allergic reaction to the contrast dye
  • Infection at the catheter site
  • Discomfort or pain at the injection site
  • Rarely, displacement or damage to the catheter
  • Thrombosis or blockage in the catheter

Benefits

  • Accurate assessment of catheter placement and function
  • Early detection of potential issues such as infections or blockages
  • Helps inform treatment decisions and management of central venous access devices
  • Immediate feedback is usually available after the procedure

Recovery

  • Patients can generally resume normal activities shortly after the procedure.
  • Drink plenty of fluids to help flush out the contrast dye.
  • Monitor the injection site for signs of infection or complications.
  • Follow-up appointments may be necessary depending on the results.

Alternatives

  • Ultrasound evaluation of the catheter
  • Non-contrast CT scan
  • Physical examination and clinical assessment
  • Each alternative has different advantages and limitations, and the choice depends on specific patient considerations and physician recommendation.

Patient Experience

Patients typically experience minimal discomfort. There might be a brief sensation of warmth as the contrast dye is injected. Pain management measures, such as local anesthetics, can be employed if needed. Post-procedure, most patients feel well enough to return to their daily routine with minimal restrictions.

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