Dialysis Procedure at a Medicare-Certified ESRD Facility for Acute Kidney Injury without ESRD (G0491)

Name of the Procedure:

Common Name: Dialysis
Medical Term: Dialysis for Acute Kidney Injury (AKI) without End-Stage Renal Disease (ESRD)

Summary

Dialysis is a treatment that performs the function of the kidneys when they are unable to do so. This procedure is used to remove waste, salt, and extra water to prevent them from building up in the body, stabilize electrolyte levels, and help control blood pressure in patients suffering from acute kidney injury but who do not have end-stage renal disease.

Purpose

Medical Conditions Addressed:

• Acute Kidney Injury (AKI) without ESRD

Goals/Expected Outcomes:

• Removal of waste products and excess fluids from the blood
• Stabilization of electrolyte balance
• Prevention of further complications related to AKI

Indications

Symptoms or Conditions:

• Decreased urine output
• Swelling in legs, ankles, and feet due to fluid retention
• Fatigue and weakness
• Nausea and vomiting

Patient Criteria:

• Diagnosed with acute kidney injury (AKI)
• Not suffering from end-stage renal disease (ESRD)
• Requiring assistance for waste removal and fluid balance

Preparation

Pre-procedure Instructions:

• Fasting may be required several hours before the procedure
• Adjustments to medications as directed by the physician
• Complete necessary diagnostic tests such as blood tests and imaging studies

Diagnostic Tests:

• Blood work to assess kidney function and electrolyte levels
• Imaging studies if required to locate vascular access points

Procedure Description

Steps Involved:

1. Access Creation: Insertion of a catheter into a vein, typically in the neck or groin.
2. Blood Flow: Patient’s blood is transferred to a dialysis machine using a series of tubes.
3. Filtration: The dialysis machine filters waste products, excess salts, and fluids from the blood.
4. Return of Clean Blood: The cleaned blood is returned to the patient’s body through the tubing system.

Tools and Equipment:

• Dialysis machine
• Catheters
• Tubing system

Anesthesia/Sedation:

• Typically, local anesthesia or sedation is not required.

Duration

The procedure typically takes about 2 to 4 hours, conducted multiple times a week based on the patient's condition.

Setting

The procedure is performed in a Medicare-certified ESRD facility designed for dialysis treatment.

Personnel

Involved Healthcare Professionals:

• Nephrologist (kidney specialist)
• Dialysis nurses and technicians
• Support staff for monitoring and assistance

Risks and Complications

Common Risks:

• Low blood pressure
• Muscle cramps
• Nausea and vomiting

Rare Complications:

• Infection at the access site
• Blood clots
• Sepsis

Management:

• Constant monitoring by healthcare professionals
• Immediate intervention if any complications arise

Benefits

Expected Benefits:

• Improvement in blood chemistry
• Reduction of fluid overload
• Relief of symptoms associated with kidney injury

Realization Timeline:

• Benefits typically observed within a few sessions

Recovery

Post-Procedure Care:

• Monitoring of vital signs
• Hydration management
• Regular follow-up appointments with the nephrologist

Recovery Time:

• Varies by individual but generally swift

Restrictions/Follow-Up:

• Limited physical activity immediately post-procedure
• Periodic assessments and continued dialysis if needed until kidney function improves

Alternatives

Other Treatment Options:

• Conservative management with medications
• Peritoneal dialysis as another form of dialysis

Pros and Cons:

• Conservative management may delay waste removal
• Peritoneal dialysis can be performed at home but involves different risks

Patient Experience

During Procedure:

• May feel a bit cold or tired
• Some mild discomfort possible at the site of catheter insertion

After Procedure:

• Fatigue is common
• Possible dizziness due to fluid removal

Pain Management/Comfort Measures:

• Pain relievers for discomfort at the access site
• Warm blankets to combat feeling cold during dialysis

Patients will often be cared for by a dedicated nursing team, ensuring a supportive and comfortable environment throughout the procedure.