CPT® Code 36570

1. Indications

The procedure described by CPT® Code 36570 is indicated for patients who require long-term venous access for various medical treatments. The following conditions may warrant the insertion of a peripherally inserted central venous access device with a subcutaneous port in children younger than 5 years of age:

• Long-term medication administration - Patients needing consistent delivery of medications, such as chemotherapy or antibiotics, may benefit from this device.
• Frequent blood draws - Children requiring regular blood sampling for laboratory tests can have reduced discomfort and trauma with a central venous access device.
• Fluid management - Patients who need ongoing fluid therapy, including hydration or nutritional support, may require this type of access.

2. Procedure

The procedure for inserting a peripherally inserted central venous access device with a subcutaneous port involves several detailed steps to ensure proper placement and functionality of the device.

• Step 1: Vein Identification - The procedure begins with the identification of a suitable large vein in the arm, typically using ultrasound guidance. This is crucial for ensuring that the selected vein is appropriate for catheter insertion.
• Step 2: Incision and Exposure - Once a vein is selected, the planned catheter insertion site is incised, and the chosen vein is carefully exposed to facilitate access.
• Step 3: Vein Puncture - Utilizing the Seldinger technique, the vein is punctured with a needle. This technique allows for a safe and controlled entry into the vascular system.
• Step 4: Guidewire Insertion - A guidewire is then inserted through the needle and advanced several centimeters into the vein, providing a pathway for subsequent device placement.
• Step 5: Introducer Sheath and Dilator Advancement - An introducer sheath and dilator are advanced over the guidewire, which is then removed, allowing for the catheter to be inserted.
• Step 6: Catheter Placement - The catheter is advanced through the introducer sheath and into the brachiocephalic vein, subclavian vein, or superior vena cava, ensuring that it is positioned correctly for optimal function.
• Step 7: Radiographic Confirmation - Radiographs are obtained to check the placement of the catheter, ensuring it is correctly positioned within the central venous system.
• Step 8: Catheter Anchoring - The catheter is anchored in the subcutaneous tissue to prevent movement and ensure stability.
• Step 9: Port Placement - A subcutaneous pocket is created for the port, and the catheter is tunneled to connect with the port, allowing for easy access.
• Step 10: Closure - Finally, the incision over the venous access site is closed, the port is sutured into place, and the pocket is closed to complete the procedure.

3. Post-Procedure

After the insertion of the peripherally inserted central venous access device with a subcutaneous port, patients will typically require monitoring for any immediate complications, such as bleeding or infection at the insertion site. It is essential to provide care instructions regarding the maintenance of the port and catheter, including how to keep the site clean and signs of potential complications to watch for. Patients may also need follow-up appointments to assess the function of the device and ensure that it remains patent for ongoing use. Proper education on the use of the device for medication administration or blood draws is also crucial for caregivers and healthcare providers involved in the patient's care.