CPT® Code 33959

1. Indications

Extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS) are indicated for patients experiencing severe respiratory or cardiac failure. The following conditions may warrant the use of ECMO/ECLS:

• Severe Respiratory Distress Patients with conditions such as acute respiratory distress syndrome (ARDS) or severe pneumonia that leads to inadequate oxygenation.
• Cardiac Failure Patients suffering from cardiogenic shock or severe heart failure where traditional support methods are insufficient.
• Post-Cardiac Surgery Support Patients requiring support following complex cardiac surgeries where heart function is compromised.
• Congenital Heart Defects Infants with congenital heart defects that impair normal blood flow and oxygenation.

2. Procedure

The procedure for repositioning peripheral arterial and/or venous cannula(e) in patients undergoing ECMO/ECLS involves several critical steps to ensure optimal placement and functionality:

• Step 1: Preparation The procedure begins with the patient being positioned appropriately, and the area around the cannula site is prepared and sterilized to minimize the risk of infection. The existing dressing and/or sutures securing the cannula to the skin are carefully removed to access the cannula.
• Step 2: Incision The physician makes an incision in the skin to access the vessel where the cannula is placed. If the cannula was previously inserted using an open technique, the existing incision may be reopened to facilitate access.
• Step 3: Cannula Detachment The sutures that secure the cannula to the vessel are cut, allowing for the cannula to be repositioned. This step is crucial as it ensures that the cannula can be manipulated without causing damage to the surrounding tissue.
• Step 4: Repositioning Under Fluoroscopic Guidance Utilizing fluoroscopic guidance, the physician gently pulls back the cannula or uses a snare to grasp it through the incision. The cannula is then manipulated to achieve optimal placement, which is confirmed through imaging to ensure that blood flow will be adequate.
• Step 5: Securing the Cannula Once the cannula is correctly positioned, it is secured in place with sutures to prevent any movement that could compromise the ECMO/ECLS support. The incision is then closed appropriately.
• Step 6: Reconnection of the ECMO/ECLS Circuit After securing the cannula, the ECMO/ECLS circuit is reconnected, and the tubing is secured to the skin using sutures and/or dressings to ensure stability and prevent dislodgement.

3. Post-Procedure

Post-procedure care involves monitoring the patient closely for any signs of complications, such as bleeding or infection at the cannula site. Continuous assessment of the ECMO/ECLS support is essential to ensure that the cannula remains optimally positioned and that blood flow is adequate. Healthcare providers will also monitor the patient's vital signs and oxygenation levels to evaluate the effectiveness of the procedure. Any necessary adjustments to the ECMO/ECLS settings will be made based on the patient's condition. Additionally, proper documentation of the procedure and any observations made during the repositioning is crucial for ongoing patient care and compliance with medical coding standards.