Understanding Fracture of Port During Procedure (F), also known as Port Catheter Fracture, TIVAD Fracture, or Venous Access Device Fracture, is crucial for accurate clinical documentation and medical coding. This resource provides information on diagnosis, treatment, and coding guidelines related to central venous catheter fractures and complications for healthcare professionals. Learn about best practices for documenting port fractures, ICD-10 codes, and strategies for preventing venous access device complications.
Also known as
Complications of surgical procedures
Covers complications arising from surgical and medical procedures, including device failures.
Surgical operation and other procedures as the cause
Classifies external causes of morbidity related to surgical and medical procedures.
Misadventures during surgical and medical care
Includes accidental injuries during medical care, like device malfunction or breakage.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is the fracture of the port intravascular?
Yes
Is the fractured fragment causing an occlusion?
No
Is the port still functional?
When to use each related code
| Description |
|---|
| Fractured port during procedure |
| Central venous catheter occlusion |
| Central venous catheter infection |
Coding requires specifying the fractured device (e.g., port, PICC, CVC) for accurate reimbursement and data analysis.
Clinical validation of the fracture is crucial. Documentation must clearly support the diagnosis and not just suspected damage.
Coding and documentation should link the fracture to the specific procedure during which it occurred for accurate causality.
Q: How can I confirm a suspected implanted port catheter fracture during a procedure, and what immediate steps should I take?
A: Suspecting an implanted port catheter fracture, especially during a procedure like power injection for CT scans or infusion therapy, requires prompt confirmation and action. While resistance during flushing or aspiration is a common initial sign, it's crucial to confirm the fracture. Fluoroscopy is the gold standard for visualizing the catheter and confirming a break, malposition, or other issues. If fluoroscopy isn't immediately available, consider obtaining a chest X-ray focused on the port area. Upon confirming the fracture, immediately stop the procedure to prevent further complications like extravasation or embolization. Aspirate any accessible fragmented catheter pieces if possible. Secure the catheter hub to prevent further movement and inform the patient. Explore how advanced imaging modalities can aid in precise localization of fractured fragments, particularly if embolization is suspected. Consult with interventional radiology for appropriate management, which may include catheter removal and replacement or endovascular retrieval of fractured pieces. Consider implementing standardized protocols for suspected catheter fractures to streamline response and minimize potential harm.
Q: What are the clinical signs and symptoms of a fractured totally implantable venous access device (TIVAD) or port, and how do these differ from other catheter-related complications?
A: Fractured totally implantable venous access devices (TIVADs), also known as ports, present unique clinical signs and symptoms that can be challenging to differentiate from other catheter-related complications. While resistance or inability to flush or aspirate from the port is a key indicator of potential fracture, it can also be seen in catheter occlusion or fibrin sheath formation. Specific signs suggestive of a fracture include pain or discomfort at the port site, especially during access, swelling around the port area, and potentially palpable catheter fragments beneath the skin. Unlike infection, which typically presents with erythema, warmth, and fever, a fractured port may not exhibit these inflammatory signs initially. Thrombosis may present with arm swelling and pain, but is less likely to be localized specifically to the port site. Distinguishing a port fracture from other complications necessitates careful assessment and appropriate imaging. Learn more about the utility of dynamic ultrasound in evaluating suspected port fractures, as it can sometimes visualize catheter movement and identify potential points of breakage. Furthermore, consider implementing a checklist for differentiating catheter-related complications to enhance accurate diagnosis and timely intervention.
Patient presented with suspected central venous access device malfunction. The patient, with a history of a tunneled implantable venous access device (TIVAD, also known as a port catheter), reported difficulty flushing or aspirating from the port. Physical exam revealed no obvious signs of infection, erythema, or swelling at the port site. However, during attempted access, resistance was encountered, suggesting possible port catheter fracture. Imaging studies, specifically a chest x-ray and/or fluoroscopy, were ordered to evaluate the integrity of the catheter and confirm the diagnosis of a fractured port. Differential diagnosis included catheter occlusion, fibrin sheath formation, and extravasation. Preliminary imaging findings suggest a break or fracture within the port catheter system. The risks and benefits of various management options, including thrombolytic therapy, guidewire exchange, or surgical removal of the fractured port, were discussed with the patient. A consult with interventional radiology was requested for definitive management of the fractured venous access device. Plan is to proceed with further diagnostic evaluation and subsequent treatment based on interventional radiology recommendations. The event was documented as a complication of an existing indwelling device. ICD-10 code T82.898A (Other complications of other internal prosthetic devices, implants and grafts) and CPT code 36589 (Repair, central venous access device, with subcutaneous port/pump; other than revision) are being considered, pending final treatment plan. Patient education regarding the potential complications of venous access devices and preventative measures was provided. Close monitoring for any signs of infection or further complications will be maintained.