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Insertion of tunneled intraperitoneal catheter for dialysis, open

CPT4 code

Name of the Procedure:

Insertion of Tunneled Intraperitoneal Catheter for Dialysis, Open

Common Name(s): Surgically-placed peritoneal dialysis catheter, Tenckhoff catheter insertion

Summary

This procedure involves surgically placing a special catheter into the abdomen to allow for peritoneal dialysis, which is a method to remove waste products and excess fluid when the kidneys can no longer perform these functions adequately.

Purpose

Medical Condition/Problem: Chronic kidney disease or kidney failure. Goals/Expected Outcomes: To provide a reliable access point for peritoneal dialysis, enabling regular dialysis treatments to manage kidney failure.

Indications

  • End-stage renal disease (ESRD)
  • Chronic kidney disease requiring dialysis
  • Patients who prefer or are medically suited for peritoneal dialysis over hemodialysis

Preparation

  • The patient may need to fast for several hours before the procedure.
  • Certain medications, especially blood thinners, may need to be adjusted.
  • Preoperative blood tests, imaging studies, and evaluation of overall health status are typically required.

Procedure Description

  1. The patient is placed under general or local anesthesia.
  2. An incision is made in the abdominal wall.
  3. A tunnel is created under the skin from the incision site to the peritoneal cavity.
  4. The catheter is inserted through this tunnel and secured in place.
  5. The other end of the catheter, which remains outside the body, is connected to dialysis equipment.
  6. The incision is closed, and the area is dressed.

Tools and Equipment: Scalpel, tunneling device, peritoneal catheter, sutures, and dialysis connection equipment.

Anesthesia/Sedation: Local or general anesthesia, depending on patient and surgeon preference.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

This procedure is performed in a hospital operating room or a specialized surgical center.

Personnel

  • Surgeon specialized in dialysis access
  • Anesthesiologist or nurse anesthetist (if general anesthesia is used)
  • Operating room nurses and surgical technicians

Risks and Complications

  • Common Risks: Infection, bleeding, catheter malfunction or displacement
  • Rare Risks: Injury to abdominal organs, peritonitis, anesthesia-related complications
  • Management: Monitoring and antibiotics for infections, surgical revision for catheter issues

Benefits

  • Expected Benefits: Effective and reliable access for peritoneal dialysis
  • Timeline: Functionality of the catheter typically established within days to weeks post-insertion

Recovery

  • Post-procedure monitoring for complications
  • Keeping the surgical site clean and dry
  • Gradual resumption of normal activities as advised by the healthcare provider
  • Follow-up appointments to ensure proper healing and catheter function

Recovery Time: Full recovery may take a few weeks, with care instructions provided for managing the catheter.

Alternatives

  • Other Options: Hemodialysis (using a hemodialysis machine and vascular access)
  • Pros and Cons: Hemodialysis requires regular visits to a dialysis center and vascular access, which may be less convenient but suitable for those unable to undergo peritoneal dialysis.

Patient Experience

  • During Procedure: Patient may feel nothing if under general anesthesia; if local anesthesia is used, there may be some pressure or pulling sensations.
  • After Procedure: Expected soreness at the incision site, temporary limitations on physical activity, and instructions for catheter care.
  • Pain Management: Pain medications and antibiotics may be prescribed to manage discomfort and prevent infection.

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