Percutaneous Drainage

 

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General Procedural Information

Percutaneous drainage is described as the treatment of choice for many types of fluid collections. Advanced imaging modalities, such as ultrasound or CT, are used to guide the needle and drainage catheter into the fluid collection.

There are many types of collections which require drainage. Left untreated, some of these collections can result in the deteriorating health of the patient or may even cause death.

Examples of fluid collections include:

• Abscess (an infected fluid collection)
• Cyst (a non-infected fluid collection)
• Pseudocyst (a fluid collection without defined walls)
• Pneumothorax (a collection of air in the chest cavity)
• Hematoma (a collection of blood), biloma (a collection of bile) or urinoma (a collection of urine)

Fluid collections may be the result of an infection, complication of surgery, trauma or may arise from an unidentified cause.

Abscess Drainage

The introduction of abscess drainage catheters can be accomplished using a trocar technique or modified trocar technique. Trocar and modified trocar techniques are generally used for small collections near the skin.

In the trocar technique, the trocar assembly is inserted into the catheter, and the catheter is introduced just like a needle into the fluid collection. The trocar is then removed and proper position of the catheter is confirmed with the injection of contrast. The inner stiffening cannula is then removed, leaving the catheter in place. If necessary, the pigtail is locked in place. If repositioning is necessary, the inner stiffening cannula is first put back into the catheter followed by the trocar. 

If using the modified trocar technique, the direct stick is still performed. However, after the trocar is removed, an .038" guidewire is inserted through the stiffening cannula before the catheter is positioned.

Another technique that is commonly used for percutaneous fluid drainage is the Seldinger technique. This technique allows the introduction of a .038" guidewire by first achieving access with a minimally invasive 21 gauge needle assembly consisting of a stylet and cannula.

Biliary Drainage

Common causes for biliary drainage include symptomatic biliary obstruction, decompression of the biliary system in preparation for surgical intervention and drainage of postoperative bilomas.

The common causes of symptomatic biliary obstruction are tumors which compress or enter the bile ducts, biliary stone disease which blocks the duct, primary sclerosing cholangitis which causes inflammation and hardening of the bile ducts, and post-operative
biliary strictures.

Percutaneous biliary drainage can provide treatment for symptomatic biliary obstruction.

Inserted into the biliary system, a catheter permits bile drainage. The catheter is positioned across the obstruction, re-establishing bile flow into the small intestine.

Urinary Drainage

Urinary drainage procedures are similar to those involving the biliary system.

The most common cause for these procedures is obstruction, especially of the upper urinary tract. Another common cause for urinary tract interventions is the development of an abnormal tube-like passage, termed a urinary fistula.

Obstruction that blocks the flow of urine can be the outcome of a number of conditions. The common causes of urinary obstruction are tumor, renal stone disease, infection and trauma. Additionally, urinary obstruction may be the result of a complication of surgery or drug therapy.

Percutaneous urinary drainage can provide treatment of urinary obstruction.

When placing a nephrostomy catheter, percutaneous access is achieved using an introducer system. After gaining access, the .038" guidewire is placed and advanced to the kidney. Then, the tract is dilated and the nephrostomy catheter is advanced and is secured. A drainage tube and bag are hooked up to the drainage catheter, allowing continuous external urine flow.

Product Considerations

Ease of introduction, patency and patient comfort are important considerations for drainage procedures. Boston Scientific provides a full line of catheters and drainage accessories that feature high-performance materials, outstanding design and quality manufacturing to help the interventionalist meet these considerations and patient needs.