IR( interventional radiology)-7

Central Venous Access Procedures

Use: For Renal dialysis (kidney disease), cancer treatment (Chemotherapy), etc.

Classification:

2 Types of classification based on the venous access device.

1.Centrally inserted.

2.Peripherally inserted. (PICC line)

1. Centrally inserted:

Insertion site-Jugular vein, Subclavian Vein, femoral vein, or IVC.

Catheter tips must terminate in the Subclavian, Brachiocephalic (Innominate) or iliac veins, SVC, IVC, or RT Atrium.

2. Peripherally inserted:

Insertion site-Basilic vein or cephalic vein.

Catheter must terminate in the Subclavian, Brachiocephalic (Innominate) or iliac veins, SVC, IVC, or RT Atrium.

The procedures involving these types of devices fall into 5 categories.

1.Insertion: Placement of catheter through the new venous access.

2.Repair: Fixing device without replacement of either Catheter port/pump.

3.Partial Replacement: Replacement of only the catheter component associated with a port/ pump (but not the entire device) via the same venous access site.

4.Complete Replacement: Complete replacement means that, removal of the entire device via the same venous access site.

5.Removal: Removal of the entire device.

If an existing central venous access device is removed and a new one placed via separate access site code both procedure.
(Removal of old, if code exists and insertion of a new device).

Guidance code

77001- Fluoroscopy Guidance

76937- Ultrasound Guidance for venous access requiring US evaluation of potential access sites, Documentation selected vessel patency, US visualization of vascular needle entry with permanent recording and reporting.

Placement:

We have look for the following criteria to the line placements
1. Age
2. Insertion site-Central line or PICC line
3. Non Tunneled or Tunneled
4. with/without Port or pump
5. Guidance- US or Fluoroscopy

Tunneled Catheter:

The vascular catheter is connected to a venous access line that is ‘tunneled’ or placed under the skin.

e.g. - Hickman, Broviac, Groshong Catheter.

Catheter Patency Check:

Why contrast injection is done through the previously placed catheter?

A previously placed central venous access device is evaluated for complications that may be interfering with its proper functioning or the ability to draw blood from the catheter. Complications are as Fibrin Sheatharound the end of the catheter, migration of the catheter tip, patency of the tubing, kinking, fracture, or leaks.

How it is performed?

A small amount of contrast agent is injected through the previously placed catheter and the CVC device is examined under fluoroscopy as the flow is evaluated. Images are documented and a Radiological report is prepared.