Name of the Procedure:

Common Name: Dialysis Access System (Implantable) Technical Term: Implantable Dialysis Access Device (HCPCS Code: C1881)

Summary

An implantable dialysis access system is a medical device surgically placed under the skin to facilitate hemodialysis for patients with kidney failure. The device provides a consistent and reliable entry point for blood removal and return during dialysis sessions, helping improve blood filtration.

Purpose

This procedure is designed to create a permanent access point for hemodialysis, which is crucial for patients with chronic kidney disease or end-stage renal disease. The goal is to provide a durable and easily accessible site to ensure effective and efficient blood purification, reducing the need for repeated needle sticks and improving dialysis outcomes.

Indications

• Chronic Kidney Disease (CKD)
• End-Stage Renal Disease (ESRD)
• Patients requiring long-term hemodialysis
• Inadequate vascular access from previous methods (e.g., arteriovenous fistula or graft)

Preparation

• Pre-procedure fasting as per doctor's instructions, typically 6-8 hours.
• Temporary cessation or adjustment of certain medications (e.g., blood thinners).
• Diagnostic tests may include blood work and vascular imaging.
• Patient education on the procedure, risks, and post-operative care.

Procedure Description

1. Anesthesia: Local or general anesthesia is administered.
2. Incision: A small surgical incision is made near a suitable blood vessel, typically in the upper arm or chest.
3. Device Placement: The implantable dialysis access device is carefully inserted under the skin and connected to a vein and artery.
4. Closure: The incision is closed with stitches and bandaged.
5. Testing: The device is tested to ensure proper blood flow and function.

Tools and equipment may include surgical instruments, the implantable device, and imaging technology for precise placement.

Duration

The procedure typically takes 1 to 2 hours.

Setting

The procedure is performed in a hospital, often in a specialized surgical suite or interventional radiology department.

Personnel

• Surgeons or vascular specialists
• Nursing staff
• Anesthesiologists
• Radiology technicians (if imaging is required)

Risks and Complications

• Common: bruising, infection at the incision site, clotting
• Rare: device malfunction, severe infection, damage to surrounding tissues or blood vessels

Management of complications may involve antibiotics for infections or additional procedures to address device issues.

Benefits

• Consistent and reliable vascular access for dialysis
• Reduced need for repeated needle sticks
• Improved dialysis efficiency and patient outcomes

Patients typically begin experiencing benefits within a few weeks as the device heals and becomes fully functional.

Recovery

• Immediate post-procedure: Observation for a few hours to monitor for complications.
• At home: Wound care instructions, pain management with prescribed medications, and activity restrictions.
• Recovery time is generally 1 to 2 weeks, with follow-up appointments to monitor healing and device function.

Alternatives

• Arteriovenous (AV) fistula: created surgically connecting an artery to a vein.
• Arteriovenous (AV) graft: involves using a synthetic tube to connect an artery and vein.
• Pros of alternatives: AV fistulas have a longer-term patency.
• Cons: Longer maturation times for fistulas, potential complications with grafts.

Patient Experience

During the procedure, patients are under local or general anesthesia, so they typically don’t feel pain. Post-procedure, patients may feel tenderness and discomfort around the incision site, which can be managed with pain medications. Follow-up includes avoiding heavy lifting and strenuous activities until fully recovered.