|Procedure Name Abscess Drainage Under Fluoroscopic,
Ultrasonic, or CT Guidance
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
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
||Mueller PR, van Sonnenberg E, and Ferrucci JT Jr, "Percutaneous
Drainage of 250 Abdominal Abscesses and Fluid Collections. Part II: Current Procedural
Concepts,"Radiology, 1984, 151:343-7.
||Sones PJ, "Percutaneous Drainage of Abdominal Abscesses,"AJR,
||van Sonnenberg E, Mueller PR, and Ferrucci JT Jr, "Percutaneous
Drainage of 250 Abdominal Abscesses and Fluid Collections. Part I: Results, Failures, and
Complications,"Radiology, 1984, 151:337-41.