Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis
CPT4 code
Name of the Procedure:
Introduction of Needle(s) and/or Catheter(s), Dialysis Circuit, with Diagnostic Angiography of the Dialysis Circuit, Including All Direct Puncture(s) and Catheter Placement(s), Injection(s) of Contrast, and All Necessary Imaging from the Arterial Anastomosis
Summary
This procedure involves inserting a needle or catheter into a dialysis circuit and using a special dye with X-rays to visualize and diagnose any blockages or issues in the circuit.
Purpose
The procedure aims to identify and diagnose problems within the dialysis circuit, which can include blockages or narrowing of blood vessels. This is crucial for patients receiving hemodialysis to ensure that their access circuit is functioning correctly.
Indications
- Reduced blood flow in the dialysis circuit
- Ineffective dialysis sessions
- Swelling or discomfort in the limb with the dialysis access
- Suspected blockages or stenosis
- Clotting within the dialysis circuit
Preparation
- Patients may be asked to fast for a few hours before the procedure.
- Medication adjustments might be necessary, such as stopping blood thinners.
- Blood tests and ultrasound exams may be conducted to assess the condition and blood flow in the access site.
Procedure Description
- The area around the dialysis access site is cleaned and sterilized.
- Local anesthesia may be administered to numb the area.
- A needle is inserted into the dialysis circuit.
- A catheter is threaded through the needle into the blood vessel.
- Contrast dye is injected through the catheter.
- X-ray images are taken to view the flow of blood and to detect any blockages or abnormalities.
- The catheter is removed, and pressure is applied to the site to prevent bleeding.
Duration
The procedure typically takes about 1 to 2 hours.
Setting
The procedure is usually performed in a hospital's interventional radiology department or a specialized outpatient clinic.
Personnel
- Interventional Radiologist
- Radiology Technologist
- Nurse
- Possibly an Anesthesiologist or Anesthesia Nurse
Risks and Complications
- Infection at the insertion site
- Bleeding or bruising
- Allergic reaction to the contrast dye
- Injury to the blood vessel
- Blood clots
Benefits
- Accurate diagnosis of blockages or issues in the dialysis circuit.
- Enables timely intervention and treatment.
- Prolongs the functionality of the dialysis access.
Recovery
- Patients are usually monitored for a few hours post-procedure for any signs of complications.
- Instructions will be given regarding care of the insertion site.
- Most patients can resume normal activities within a day or two.
- Follow-up appointments may be necessary to discuss results and next steps.
Alternatives
- Duplex ultrasound (non-invasive but may be less detailed)
- MR angiography (useful but may not be suitable for all patients)
- Direct surgical intervention (more invasive)
Patient Experience
During the procedure, the patient may feel slight pressure or a stinging sensation during needle insertion. Post-procedure, they might experience minor discomfort or bruising at the puncture site. Pain management options and comfort measures will be provided as needed.