CPT® Code 36557

Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; younger than 5 years of age

A tunneled centrally inserted central venous catheter (CVC) is a medical device that is inserted into a large vein to provide long-term access to the bloodstream. This procedure is specifically indicated for patients younger than 5 years of age. The catheter is designed to terminate in major veins such as the subclavian, brachiocephalic, or iliac veins, as well as the superior or inferior vena cava, or the right atrium. The insertion of a tunneled CVC involves creating a subcutaneous tunnel that allows the catheter to be placed into the jugular, subclavian, or femoral vein, with the jugular vein being the most commonly used access site for this type of device. The procedure typically requires the use of local anesthesia at the puncture site to minimize discomfort. The Seldinger technique is employed to access the chosen vein, which involves puncturing the skin and vein with a needle, followed by the insertion of a guidewire. This guidewire facilitates the creation of a subcutaneous tunnel through which the catheter is advanced. The placement of the catheter is confirmed through imaging guidance, which may be separately reportable, ensuring that the catheter tip is positioned correctly within the central venous system. After the catheter is secured and the incision is closed, a dressing is applied to protect the insertion site. This procedure is crucial for patients requiring long-term intravenous therapy, such as chemotherapy or total parenteral nutrition.