interventional radiology2
TRANSCRIPT
RESULTS OF BIOPSY
+ve diagnosis between 70 et 100%.
Least performance in lymphoma
ABDOMINAL COLLECTION ABDOMINAL COLLECTION ASPIRATION & DRAINAGEASPIRATION & DRAINAGE
DIRECT METHOD 1 drain
1 Fixation system 1 3-way connector1 tubular connection
1 sterile urine bag Potentially suture kit and needle
holder
SELDINGER TECHNIQUEAdd
1 Puncture needle1 guidewire
1 dilator
STERILE MATERIEL Drainage
Direct Puncture
Seldinger Technique
DRAINAGEDRAINAGE
Fine needle allow to precise the nature of the fluid to drain.
And to adapt caliber of drain
Never empty before draining
INTERVENTIONAL PROCEDURE
Radiologist perform disinfection with antiseptic iodinated solution (Povidone(.Locale anesthesia (Lidocaïne 1%(.
Large skin incision (caliber of drain(US-guided puncture and drain positioning.
Technician may help for gain and depth adjustment of the US machine, Doppler activation and good contact between probe and skin by alcohol or betadine
Fixation of drain by radiologist (2 zones of fixation(Dressing is done by the technician. Drainage bag is left dependant (never under aspiration(
Collection
drain
Drain positioning
INTERVENTIONNEL
DRAINAGEDRAINAGE
If guidwire too soft: risk of outside curve (curling(If guidwire too rigid : risk posterior wall injury and
dissemination.No ‘locking’ pigtail catheter in abcess except transrectal or
vaginal abcess.Kinking of catheter in the wall
AFTER THE INTERVENTIONAL PROCEDURE
Verification of discharge flow in the drain.
Follow-up form & potential specimens joined. Pt. lying on point of puncture (compression(
Patient sent back to his ward.
FOLLOW-UP AFTER INTERVENTIONAL PROCEDURE
Verification of discharge flow in the drain.Clinical state improvementFollow-up when no more discharge comes out.
Clamping Test (2-3j(
If persistance : search for fistula
AFTER INTERVENTIONAL PROCEDURE
Verification of discharge flow in the drain.
Follow-up: Emptying – flush with10 cc normal saline with re-aspiration - AB IV : no flushingDecreasing dischargeClamping Test after follow-up US and clinical improvement.
PATIENT Skin cleaning in 4 steps
- detersion with cleaning solution- Rince with Sodium Chloride- Dry with sterile gauze- Disinfection with antiseptic solution
Interventional Ultrasound
In case of wound:
Cover the probe with sterile protection
Cover the lesion with transparent sterile dressing
Advantages •anatomy
•Content
Disadvantages
•Long•Axial only or oblique axial (limited(
•Mobility
•Position /Gantry Dimension•Laser beam
• Monitor in the room
•IV (ureter, necrosis(•Cooperation (apnea(
•Needle guide
• Needle extremity (same apnea(•Coaxial System (No of samples(
LiverAnterior abdomen
LiverUSRules: Pass through normal liver
Biopsy of the lesion’s wall Needle retrieval during blocked expiration
Ambulatory (outpatient( Prevent shoulder pain after (20%(
……Breast cancer – ovarian masses
-Peritoneal carcinomatosis with ascites (cytology non
contributive(-origin : type de cancer?
PancreasCT or USRules: Use the technique that best shows the lesion
Avois gastric puncture, otherwise 20G aspiration always sufficientIf suspected multicystic lesion avoid colon puncture
Risks: Hemorrhage by vascular injury Acute pancréatitis if normal pancreas is injured
Passing through normal liver
US/CT
US/CT