End stage renal disease patient requiring hemodialysis documented to have received vascular access other than autogenous av fistula
HCPCS code
Name of the Procedure:
Vascular Access for Hemodialysis (Non-Autogenous AV Fistula)
Summary
This procedure involves creating a vascular access point necessary for hemodialysis treatment in patients with End Stage Renal Disease (ESRD). The vascular access used is not an autogenous arteriovenous (AV) fistula, but rather an alternative type such as a synthetic graft or catheter.
Purpose
The procedure is designed to enable effective and efficient hemodialysis for patients with ESRD. The goal is to provide a reliable access point for dialysis treatment, ensuring adequate blood flow for the removal of waste products and excess fluids from the blood.
Indications
This procedure is indicated for ESRD patients requiring hemodialysis but who are not candidates for an autogenous AV fistula. Indications include inadequate veins for fistula creation, previous failed fistulas, or urgent need for dialysis access.
Preparation
Patients may be instructed to avoid certain medications, such as blood thinners, prior to the procedure. Blood tests and vascular mapping with ultrasound or other imaging may be performed to assess the suitable sites for access.
Procedure Description
- Local Anesthesia: The site of access is numbed with local anesthesia.
- Incision: An incision is made at the chosen vascular site.
- Insertion: Depending on the type, a synthetic graft or catheter is inserted and connected to the arterial and venous systems.
- Securing Access: The access is secured and tested to ensure proper blood flow.
Tools used may include scalpels, needles, guidewires, and various types of grafts or catheters.
Duration
Typically, the procedure takes about 1 to 2 hours, but this can vary depending on complexity and patient condition.
Setting
The procedure is generally performed in a hospital operating room or an outpatient surgical center.
Personnel
The procedure involves a vascular surgeon, surgical nurses, and occasionally an anesthesiologist if sedation is required beyond local anesthesia.
Risks and Complications
Common risks include infection, bleeding, and thrombosis (clotting) at the access site. Rare complications can include damage to surrounding blood vessels or tissues. Appropriate management includes antibiotics for infection and clot-dissolving medications.
Benefits
The primary benefit is the establishment of a functional vascular access for hemodialysis, enabling ongoing treatment for ESRD. Benefits are typically realized shortly after the access site is healed and dialysis can commence.
Recovery
Post-procedure care includes monitoring for signs of infection or complications, keeping the site clean and dry, and possibly avoiding heavy lifting with the affected limb. Recovery time varies but patients can usually resume normal activities within a few days to a week, with follow-up appointments to ensure the access is functioning properly.
Alternatives
Alternatives include peritoneal dialysis or kidney transplantation. Each option has its own set of benefits and drawbacks, with dialysis being less invasive but requiring regular treatment sessions, whereas transplantation offers more permanence but comes with higher surgical risk and potential for organ rejection.
Patient Experience
Patients might feel some discomfort during local anesthesia administration and mild soreness after the procedure. Pain management can include over-the-counter pain relievers and prescription medications as needed. Comfort measures include following post-procedure care instructions to prevent complications and promote healing.