CPT® Code 33957

1. Indications

The procedure described by CPT® Code 33957 is indicated for patients who require repositioning of peripheral arterial and/or venous cannula(e) as part of their extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS) treatment. The following conditions may necessitate this procedure:

• Severe respiratory failure - Conditions that impair the lungs' ability to oxygenate blood effectively.
• Cardiac failure - Situations where the heart is unable to pump sufficient blood to meet the body's needs.
• Congenital heart defects - Structural abnormalities of the heart present at birth that may require ECMO/ECLS support.
• Post-operative support - Patients recovering from cardiac or thoracic surgery who may need temporary support for heart and lung function.

2. Procedure

The procedure for repositioning peripheral arterial and/or venous cannula(e) under CPT® Code 33957 involves several critical steps to ensure the effective functioning of the ECMO/ECLS system. The following procedural steps are outlined:

• Step 1: Preparation - The procedure begins with the removal of the dressing and/or sutures that secure the cannula(e) to the skin. This step is essential to allow for safe manipulation of the cannula(e) without causing damage to the surrounding tissue.
• Step 2: Fluoroscopic Guidance - The physician utilizes fluoroscopic imaging to visualize the position of the cannula(e) within the vascular system. This imaging technique provides real-time feedback, allowing for precise adjustments during the repositioning process.
• Step 3: Cannula Manipulation - The physician gently pulls back the cannula(e) using controlled pressure or employs a snare to grasp the cannula(e) for repositioning. This manipulation is performed carefully to avoid complications and ensure optimal placement.
• Step 4: Confirmation of Placement - Once the cannula(e) have been repositioned, the physician confirms that the new placement is optimal for effective ECMO/ECLS support. This confirmation is crucial to ensure that blood flow and oxygenation are adequately restored.
• Step 5: Reconnection and Securing - After confirming the correct placement, the ECMO/ECLS circuit is reconnected. The tubing is then secured to the skin using sutures and/or dressings to prevent movement and maintain stability during the patient's ongoing treatment.

3. Post-Procedure

Post-procedure care following the repositioning of peripheral cannula(e) involves monitoring the patient closely for any signs of complications, such as bleeding, infection, or improper cannula placement. Continuous assessment of the patient's hemodynamic status and oxygenation levels is essential to ensure that the ECMO/ECLS system is functioning effectively. Additionally, the site of cannula insertion should be regularly inspected for any signs of irritation or infection. The healthcare team must also provide appropriate education to the caregivers regarding signs of potential complications and the importance of follow-up care. The overall goal of post-procedure management is to ensure the patient's safety and the continued effectiveness of the ECMO/ECLS support system.