Interventional radiology2

RESULTS OF BIOPSYRESULTS OF BIOPSY

+ve diagnosis between 70 et 100%.

Least performance in lymphoma

ABDOMINAL COLLECTION ASPIRATION & ABDOMINAL COLLECTION ASPIRATION & ABDOMINAL COLLECTION ASPIRATION & ABDOMINAL COLLECTION ASPIRATION & ABDOMINAL COLLECTION ASPIRATION & ABDOMINAL COLLECTION ASPIRATION &

DRAINAGEDRAINAGE

ABDOMINAL COLLECTION ASPIRATION & ABDOMINAL COLLECTION ASPIRATION &

DRAINAGEDRAINAGE

DIRECT METHOD

�1 drain

�1 Fixation system

�1 3-way connector

SELDINGER TECHNIQUE

�Add

�1 Puncture needle

�1 guidewire

STERILE MATERIEL STERILE MATERIEL

Drainage

�1 tubular connection

�1 sterile urine bag

�Potentially suture kit and needle

holder

�1 dilator

Direct Puncture

Seldinger Technique

DRAINAGEDRAINAGE

�Fine needle allow to precise the nature of

the fluid to drain.

�And to adapt caliber �And to adapt caliber of drain

�Never empty before draining

INTERVENTIONAL PROCEDUREINTERVENTIONAL 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.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 positioning

INTERVENTIONNEL

Collection

drain

Drain positioning

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 PROCEDUREAFTER 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 PROCEDUREFOLLOW-UP AFTER INTERVENTIONAL PROCEDURE

Verification of discharge flow in the drain.

Clinical state improvement

Follow-up when no more discharge comes out.

Clamping Test (2-3j)Clamping Test (2-3j)

If persistance : search for fistula

AFTER INTERVENTIONAL PROCEDUREAFTER INTERVENTIONAL PROCEDURE

Verification of discharge flow in the drain.

Follow-up: Emptying – flush with10 cc normal saline

with re-aspiration - AB IV : no flushingwith re-aspiration - AB IV : no flushing

Decreasing discharge

Clamping Test after follow-up US and clinical

improvement.

PATIENT

Skin cleaning in 4 steps

- detersion with cleaning solution

- Rince with Sodium Chloride

Interventional UltrasoundInterventional Ultrasound

- Rince with Sodium Chloride

- Dry with sterile gauze

- Disinfection with antiseptic solution

In case of wound:

Cover the probe with sterile protection

Cover the lesion with transparent sterile dressing

INTERVENTIONAL RADIOLOGY

CT

Advantages

•anatomy

•Content

Disadvantages

•Long

•Axial only or oblique axial (limited)

•Mobility

INTERVENTIONAL RADIOLOGY

US/CT

•Position /Gantry Dimension

•Laser beam

•Monitor in the room

•IV (ureter, necrosis)

•Cooperation (apnea)

•Needle guide

INTERVENTIONAL RADIOLOGY

US/CT

•Needle extremity (same apnea)

•Coaxial System (No of samples)

INTERVENTIONAL RADIOLOGY

US/CT

Liver

Anterior abdomen

INTERVENTIONAL RADIOLOGY

US/CT

LiverUSUS

Rules: 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?

INTERVENTIONAL RADIOLOGY

US/CT

Pancreas

CT or USRules: Use the technique that best shows the lesionAvois gastric puncture, otherwise 20G aspiration Avois gastric puncture, otherwise 20G aspiration always sufficientIf suspected multicystic lesion avoid colon puncture

Risks: Hemorrhage by vascular injuryAcute pancréatitis if normal pancreas is injured

Passing through normal liver

US/CT

US/CT