Name of the Procedure:

Fluoroscopic guidance for central venous access device placement, replacement, or removal (includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or catheter)

Summary

This procedure involves the use of fluoroscopy, a type of real-time X-ray technology, to guide the insertion, replacement, or removal of a central venous catheter. This catheter is a long, thin tube placed in a large vein, usually in the chest.

Purpose

The procedure is used to ensure accurate and safe placement, adjustment, or removal of central venous access devices, which are essential for administering medications, fluids, blood products, or for drawing blood samples.

Indications

• Intravenous delivery of medications or nutrition
• Hemodialysis or plasmapheresis
• Frequent blood draws
• Chemotherapy
• Severe infections requiring long-term antibiotics

Preparation

• Fasting for several hours before the procedure
• Adjusting medications, especially blood thinners, as instructed by the physician
• Pre-procedure blood tests and imaging studies

Procedure Description

1. The patient lies on an X-ray table.
2. Local anesthesia is applied to numb the insertion site.
3. A small incision is made, and a needle is inserted into the vein.
4. A guidewire is passed through the needle into the vein.
5. The fluoroscope is used to guide the catheter over the guidewire into the correct position.
6. Once in place, the guidewire is removed, and the catheter is secured.
7. The insertion site is closed and dressed.

Duration

The procedure typically takes 30 minutes to 1 hour.

Setting

Hospital, outpatient clinic, or surgical center.

Personnel

• Interventional radiologist or specialized surgeon
• Radiology technician
• Nursing staff
• Anesthesiologist (if sedation is required)

Risks and Complications

• Infection
• Bleeding or hematoma
• Pneumothorax (collapsed lung)
• Thrombosis (blood clot)
• Catheter malfunction or misplacement
• Allergic reaction to contrast material

Benefits

• Accurate placement ensures effective treatment
• Minimally invasive with quick recovery
• Real-time imaging minimizes risks and complications
• Immediate use of the catheter is often possible

Recovery

• Monitoring for a few hours post-procedure
• Keeping the insertion site clean and dry
• Avoiding heavy lifting and strenuous activities for a few days
• Follow-up appointments for catheter management and site inspection

Alternatives

• Ultrasound-guided catheter placement
• Surgery for catheter placement
• Peripheral intravenous lines (for short-term use)
• Pros and cons should be discussed with the healthcare provider to determine the best option.

Patient Experience

During the procedure, the patient may feel slight pressure or discomfort at the insertion site. Sedation or relaxation medication may be offered to enhance comfort. Post-procedure, mild soreness at the site is common and can be managed with over-the-counter pain relievers.