Replacement of gastrostomy or cecostomy (or other colonic) tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report
CPT4 code
Name of the Procedure:
Replacement of gastrostomy or cecostomy (or other colonic) tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation, and report.
Summary
In this procedure, a gastrostomy or cecostomy tube, which is used for feeding or draining, is replaced through the skin using imaging techniques for precise placement. Fluoroscopy, a type of real-time X-ray, is used along with contrast injection to ensure proper tube positioning.
Purpose
The primary purpose is to replace a malfunctioning, damaged, or blocked gastrostomy or cecostomy tube. The goal is to ensure the new tube is correctly positioned for optimal function, preventing complications like leakage, infection, or incorrect nutrient delivery.
Indications
- Blocked or dislodged gastrostomy or cecostomy tube
- Infection or irritation around the tube site
- Tube malfunction affecting feeding or drainage
- Routine tube replacement as recommended by a healthcare provider
Preparation
- Patients may need to fast for several hours before the procedure.
- Medication adjustments, especially blood thinners, may be necessary.
- Pre-procedure imaging or fluoroscopy might be required to assess the current tube placement.
Procedure Description
- The patient is positioned appropriately, and local anesthesia is administered to numb the insertion site.
- An initial scan using fluoroscopy is performed to visualize the existing tube.
- A contrast agent is injected to highlight the pathway and ensure correct positioning.
- The existing tube is carefully removed.
- A new tube is introduced through the same pathway, guided by fluoroscopy.
- Contrast is injected again to confirm the tube's correct placement.
- Final images are taken for documentation, and the new tube is secured.
Duration
The procedure typically takes around 30 to 60 minutes.
Setting
This procedure is usually performed in a hospital's radiology department or an outpatient surgical center equipped with fluoroscopic imaging technology.
Personnel
- Interventional radiologist or gastroenterologist
- Radiologic technologist
- Nurses
- Anesthesiologist or nurse anesthetist (if sedation or general anesthesia is used)
Risks and Complications
- Infection at the insertion site
- Bleeding or leakage around the tube
- Allergic reaction to contrast material
- Inaccurate tube placement
- Injury to surrounding organs
Benefits
- Restores proper function of the feeding or drainage tube
- Minimizes discomfort and complications associated with a malfunctioning tube
- Quick recovery allowing resumption of feeding or drainage soon after the procedure
Recovery
- Patients are monitored for a short period post-procedure.
- Instructions for site care and any restrictions on activity are provided.
- Pain management guidelines are given if necessary.
- Follow-up appointments may be necessary to monitor tube function and site health.
Alternatives
- Surgical replacement of the tube
- Endoscopic tube replacement
- Non-surgical management, such as adjusting the existing tube or using medications
Patient Experience
During the procedure, the patient may feel mild discomfort or pressure at the insertion site. Post-procedure, there may be some soreness and the need to avoid strenuous activities until fully healed. Pain management will be provided, and most patients can resume normal activities within a few days.