interventional radiology2
DESCRIPTION
TRANSCRIPT
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