Chemotherapy administration, intra-arterial; infusion technique, initiation of prolonged infusion (more than 8 hours), requiring the use of a portable or implantable pump
CPT4 code
Name of the Procedure:
Chemotherapy Administration, Intra-Arterial; Infusion Technique, Initiation of Prolonged Infusion (more than 8 hours), Requiring the Use of a Portable or Implantable Pump
Summary
This procedure involves administering chemotherapy directly into an artery through a catheter using a portable or implantable pump. This technique allows chemotherapy drugs to be delivered over an extended period, typically more than 8 hours.
Purpose
The primary goal of this procedure is to target cancer cells more effectively by delivering high concentrations of chemotherapy directly to a tumor site while minimizing exposure to the rest of the body. It is used to treat certain types of localized cancers that are not responding well to systemic chemotherapy.
Indications
This procedure is indicated for patients with localized tumors, especially in organs like the liver or limbs, where selective delivery of chemotherapy can maximize the drug's effectiveness and minimize systemic side effects. It is typically suitable for patients who have not responded to traditional chemotherapy methods or who are not candidates for surgical tumor removal.
Preparation
Patients may need to fast for several hours before the procedure. Medications may need adjustment, particularly blood thinners. A series of diagnostic tests, including blood work and imaging studies (like CT scans or MRIs), are often conducted to map the arterial system and plan the catheter's placement.
Procedure Description
- Patient is positioned and prepped, with the insertion site sterilized.
- Local anesthesia is applied to the insertion site, typically in the groin area.
- A catheter is inserted into the femoral artery and guided to the artery supplying the tumor.
- The portable or implantable pump is connected to the catheter.
- Chemotherapy drugs are loaded into the pump, programmed to release over the prescribed time (more than 8 hours).
The insertion site is dressed, and the pump is secured for ambulatory use if portable.
Tools/Equipment: Catheters, portable/implantable pump, imaging guidance (fluoroscopy, ultrasound), and chemotherapy drugs.
Anesthesia: Local anesthesia at the catheter insertion site.
Duration
The insertion process typically takes 1-2 hours. The infusion itself lasts more than 8 hours, depending on the treatment plan.
Setting
The catheter insertion and initiation of chemotherapy are performed in a hospital setting, often in an interventional radiology or operating room.
Personnel
The procedure involves an interventional radiologist or oncologist, specialized nurses, a pharmacist, and other supporting staff as needed.
Risks and Complications
Common risks include infection, bleeding, and catheter-related issues. Rare complications could involve arterial damage, blood clots, or unintended delivery of chemotherapy to non-target areas. Management involves close monitoring, use of antibiotics for infections, and potential adjustments in catheter placement or infusion rate.
Benefits
The primary benefit is a higher concentration of chemotherapy delivered directly to the tumor site, which can lead to better tumor shrinkage with reduced systemic toxicity. Patients may start to see benefits within a few weeks after treatment initiation.
Recovery
Post-procedure care includes monitoring for any immediate complications like bleeding or infection at the catheter site. Patients are generally instructed to rest, avoid strenuous activities, and follow a schedule for follow-up visits to monitor progress and pump functionality. Recovery time can vary, but most patients can resume normal activities within a few days, aside from pump management.
Alternatives
Other treatments include systemic chemotherapy, radiation therapy, or surgical removal of the tumor. Each alternative has unique pros and cons, such as broader systemic side effects from systemic chemotherapy, potential tissue damage from radiation, or surgical risks, respectively.
Patient Experience
During the procedure, the patient might feel some discomfort at the insertion site, but pain is managed with local anesthesia. Post-procedure, patients carrying portable pumps need to adjust to managing the device. Some mild pain or discomfort at the catheter site can be expected, with prescribed pain relievers provided for management. Most patients can manage daily routines with some modifications and regular follow-up for adjustments and monitoring.