interventional radiology2

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RESULTS OF BIOPSY +ve diagnosis between 70 et 100%. Least performance in lymphoma

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Page 1: Interventional radiology2

RESULTS OF BIOPSY

+ve diagnosis between 70 et 100%.

Least performance in lymphoma

Page 2: Interventional radiology2

ABDOMINAL COLLECTION ABDOMINAL COLLECTION ASPIRATION & DRAINAGEASPIRATION & DRAINAGE

Page 3: Interventional radiology2

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

Page 4: Interventional radiology2

Direct Puncture

Page 5: Interventional radiology2

Seldinger Technique

Page 6: Interventional radiology2

DRAINAGEDRAINAGE

Fine needle allow to precise the nature of the fluid to drain.

And to adapt caliber of drain

Never empty before draining

Page 7: Interventional radiology2

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(

Page 8: Interventional radiology2

Collection

drain

Drain positioning

INTERVENTIONNEL

Page 9: Interventional radiology2

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

Page 10: Interventional radiology2

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.

Page 11: Interventional radiology2

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

Page 12: Interventional radiology2

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.

Page 13: Interventional radiology2

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

Page 14: Interventional radiology2

Advantages •anatomy

•Content

Disadvantages

•Long•Axial only or oblique axial (limited(

•Mobility

Page 15: Interventional radiology2

•Position /Gantry Dimension•Laser beam

• Monitor in the room

•IV (ureter, necrosis(•Cooperation (apnea(

•Needle guide

Page 16: Interventional radiology2

• Needle extremity (same apnea(•Coaxial System (No of samples(

Page 17: Interventional radiology2

LiverAnterior abdomen

Page 18: Interventional radiology2

LiverUSRules: Pass through normal liver

Biopsy of the lesion’s wall Needle retrieval during blocked expiration

Ambulatory (outpatient( Prevent shoulder pain after (20%(

Page 19: Interventional radiology2

……Breast cancer – ovarian masses

-Peritoneal carcinomatosis with ascites (cytology non

contributive(-origin : type de cancer?

Page 20: Interventional radiology2

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

Page 21: Interventional radiology2

US/CT

Page 22: Interventional radiology2

US/CT