End-stage renal disease (ESRD) related services for dialysis less than a full month of service, per day; for patients younger than 2 years of age
CPT4 code
Name of the Procedure:
Daily Dialysis for ESRD Patients Younger Than 2 Years: Peritoneal Dialysis and Hemodialysis
Summary
Daily dialysis for young patients with end-stage renal disease (ESRD) involves cleansing the blood of waste products and excess fluids using peritoneal dialysis or hemodialysis methods.
Purpose
Medical Condition:
- End-stage renal disease (ESRD)
Goals:
- Remove waste products and excess fluids from the blood
- Maintain electrolyte balance
- Improve quality of life and prolong survival
Indications
Symptoms or Conditions:
- Severe kidney function impairment
- Fluid overload, uremia, electrolyte imbalances
Patient Criteria:
- Younger than 2 years of age
- Diagnosed with ESRD
Preparation
Instructions:
- No solid food 4-6 hours before the procedure
- Clear fluids allowed up to 2 hours before the procedure
Diagnostic Tests:
- Blood tests to assess kidney function and electrolyte levels
- Ultrasound or other imaging if necessary
Procedure Description
Steps:
Peritoneal Dialysis:
- A catheter is inserted into the peritoneal cavity.
- Dialysis solution is infused through the catheter.
- Waste products diffuse across the peritoneal membrane into the solution, which is then drained.
Hemodialysis:
- Blood is drawn from the body through a vascular access like a central venous catheter.
- It is filtered through a dialyzer, which removes wastes and extra fluids.
- Cleaned blood is returned to the body.
Tools:
- Dialysis machine, sterilized catheter, dialyzer, dialysis solution
Sedation:
- Minimal or no sedation for peritoneal dialysis; local anesthesia for catheter placement in hemodialysis
Duration
Typically 1-3 hours per session, depending on patient needs and type of dialysis
Setting
- Hospital, specialized pediatric dialysis centers, or outpatient clinics
Personnel
- Pediatric nephrologist
- Dialysis nurse
- Technicians specialized in dialysis procedures
Risks and Complications
Common Risks:
- Infection at catheter site
- Fluid imbalance
Rare Risks:
- Bowel perforation (peritoneal dialysis)
- Cardiovascular issues or clotting problems (hemodialysis)
Management:
- Antibiotics for infections
- Careful monitoring of weight and fluid status
Benefits
Expected Benefits:
- Improved waste removal and fluid balance
- Enhanced quality of life
- Stabilized health parameters
Timeframe:
- Benefits are typically noticeable within days to weeks of regular treatment.
Recovery
Post-Procedure Care:
- Regular monitoring of vitals and blood tests
- Care of the dialysis access site
Recovery Time:
- Minimal downtime; ongoing process until a kidney transplant or better kidney function is established
Restrictions:
- Dietary adjustments and fluid restrictions as instructed by a healthcare provider
Follow-Up:
- Regular follow-up appointments to adjust treatment as needed
Alternatives
Other Options:
- Kidney transplant
- Conservative management with medication and dietary changes
Pros and Cons:
- Kidney transplant: Long-term solution but requires matching donor and surgical risks.
- Conservative management: Non-invasive but often insufficient for ESRD.
Patient Experience
During the Procedure:
- Minimal discomfort; parents can often stay with the child.
- Mild sedation or distraction techniques used to keep the child calm.
After the Procedure:
- Minor soreness or bruising at the catheter site
- Regular pain management strategies include acetaminophen
Pain is generally well-managed, ensuring the child is as comfortable as possible during and after the procedure.