Synonyms Catheter Drainage; External Decompression; Percutaneous Drainage

Applies to Drainage of Fluid Collection

Procedure Commonly Includes Placement of a catheter to drain or decompress an abscess or fluid collection. These examinations are typically performed under fluoroscopic, ultrasonic, or computed tomographic guidance. Aspirated material is usually sent for Gram's stain and culture.

Indications Presence of an intra-abdominal, intrathoracic, or pelvic abscess or presence of a symptomatic fluid collection such as a hematoma, hygroma, lymphocele, urinoma, biloma, or pseudocyst.

Contraindications A fluid or abscess collection which is inaccessible to percutaneous needle puncture, bleeding abnormalities, elevated prothrombin or partial thromboplastin times.

Patient Preparation Informed consent is obtained from the patient. The patient is placed on a clear liquid diet starting 4 hours before the procedure. Recent coagulation parameters (PT, PTT, and platelet count) are recorded on the chart. In cases of abscesses and infected fluid collections, broad spectrum antibiotics are administered.

Aftercare Patient is placed on bedrest for approximately 4 hours after the procedure. Vital signs should be obtained every 30 minutes for 2 hours, then every hour for 4 hours. During this time, the patient should be closely observed for any evidence of internal or external bleeding. The drainage catheters should be connected to a collection bag. Appropriate precautions should be made that the catheter is not inadvertently pulled out.

Special Instructions These examinations are usually arranged by the requesting physician in consultation with the interventional radiologist. Any previous imaging studies of the area to be drained should be made available to the interventional radiologist. Any bleeding abnormalities should be corrected beforehand.

Complications Most complications are related to either bleeding or sepsis. Delayed complications include fistula formation, plugging, or dislodgment of the drainage catheter.

Equipment Fluoroscopy, computed tomography, or ultrasonography; appropriate interventional needles, wires, and catheters

Technique The abscess or fluid collection is localized with ultrasound, CT, or occasionally fluoroscopy and the appropriate entry path is determined. Local anesthesia is instilled at the appropriate site and a needle with or without a sheath is guided into the collection. Fluid is aspirated and sent to the laboratory for appropriate bacteriological, cytological, and/or chemical analysis. If a sheathed needle system has been used, the sheath is advanced over the needle into the fluid collection. Otherwise, a wire is passed through the needle, the needle is removed, and a catheter is then inserted over the wire into the fluid collection. The catheter is then secured in place and connected to an external drainage bag.

Limitations Some fluid collections do not lend themselves to percutaneous drainage due to the presence of multiple septations within the collection. Some collections are inaccessible to percutaneous drainage secondary to overlying bony structures or close approximation to a vascular structure. If the material to be drained is very viscous, it may be necessary to place progressively larger drainage catheters.

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