CT-Guided Abdominal Drain Placement

 

Date of procedure:

[ ]

 

Indication:

Drainage of fluid collection

 

Operators:

Sarel Gaur MD

 

Medications:

Versed IV:  [ ] ml total

Fentanyl IV:  [ ] ml total

 

Contrast:

[ ] ml of Omnipaque intravenous

 

DLP:

[ ]

 

Access site(s):

Right abdomen

 

Device(s):

8 French multipurpose locking pigtail catheter

 

Complications:

None

 

Technique and Findings:

 

1. Informed Consent was obtained.

2. Patient was brought to the CT suite and placed supine on the table.

3. RN was monitoring vital signs throughout.  IV sedation was utilized.

4. A limited CT was performed to identify the fluid collection in the [right abdomen].

5. Radiopaque markers were placed on the skin.

6. A point of entry was marked.

7. The area was prepped with chlorhexidine solution and draped.  Lidocaine was given for local anesthesia.

8. Under intermittent CT guidance, the fluid collection was accessed using a 5 F Yueh catheter-needle.

9. When fluid was encountered, the catheter was pushed forward and the needle removed.

10. An Amplatz wire was advanced through the catheter and the catheter removed.

11. The 8F drainage catheter and inner metal stiffener were advanced over the wire.  The stiffener was removed and the catheter was advanced into and pigtailed within the collection.

12. CT was used to confirm placement of the catheter within the collection.

13. A sample was removed and sent for lab analysis.

14. The catheter was secured with a silk suture and a sterile dressing placed.  A gravity drainage bag was attached.

15. The procedure was terminated and the patient was sent back to the holding area.

 

Impression:

Successful placement of a 8F locking pigtail multipurpose drainage catheter within the [right abdominal fluid collection].

 

Plan or Recommendations:

Please flush the catheter qday with 5 cc of sterile saline.  A fluoroscopic drain check can be obtained within 3-5 days.

 

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CT-Guided Pelvic Drain Placement

 

Date of procedure:

[ ]

 

Indication:

Drainage of pelvic fluid collection

 

Operators:

Sarel Gaur MD

 

Medications:

Versed IV:  [ ] ml total

Fentanyl IV:  [ ] ml total

 

Contrast:

[ ] ml of Omnipaque intravenous

 

DLP:

[ ]

 

Access site(s):

Right pelvis

 

Device(s):

8 French multipurpose locking pigtail catheter

 

Complications:

None

 

Technique and Findings:

 

1. Informed Consent was obtained.

2. Patient was brought to the CT suite and placed prone on the table.

3. RN was monitoring vital signs throughout.  IV sedation was utilized.

4. A limited CT was performed to identify the fluid collection in the [right pelvis].

5. Radiopaque markers were placed on the skin.

6. A point of entry was marked.

7. The area was prepped with chlorhexidine solution and draped.  Lidocaine was used for local anesthesia.

8. Under intermittent CT guidance, the fluid collection was accessed using a 5 F Yueh catheter-needle.

9. When fluid was encountered, the catheter was pushed forward and the needle removed.

10. An Amplatz wire was advanced through the catheter and the catheter removed.

11. The 8F drainage catheter and inner metal stiffener were advanced over the wire.  The stiffener was removed and the catheter was advanced into and pigtailed within the collection.

12. CT was used to confirm placement of the catheter within the collection.

13. A sample was removed and sent for lab analysis.

14. The catheter was secured with a silk suture and a sterile dressing placed.  A gravity drainage bag was attached.

15. The procedure was terminated and the patient was sent back to the holding area.

 

Impression:

Successful placement of an 8F locking pigtail multipurpose drainage catheter within the [right pelvic fluid collection].

 

Plan or Recommendations:

Please flush the catheter qday with 5 cc of sterile saline.  A fluoroscopic drain check can be obtained within 3-5 days.

 

 

 

 

US Guided Paracentesis

 

Date of procedure:

[ ]

 

Indication:

Drainage of ascites

 

Operators:

Sarel Gaur MD

 

Medications:

Lidocaine local anesthesia

Versed IV:  [ ] ml total

Fentanyl IV:  [ ] ml total

 

Contrast:

NA

  

Access site(s):

Right lower quadrant.

 

Device(s):

5F, 7 cm, Yueh catheter-needle

 

Complications:

None

 

Technique and Findings:

 

1. Informed Consent was obtained.

2. Patient was brought to the US suite and placed supine in the stretcher.

3. RN was monitoring vital signs throughout. 

4. US was used to identify a pocket of fluid in the R lower quadrant.

5. A point of entry was marked.

6. The area was prepped with chlorhexidine solution and draped.

7. Lidocaine was given for local anesthesia.

8. Under constant ultrasound guidance, the fluid was accessed using the 5F, 7 cm Yueh-catheter needle. 

9. When satisfactory access was obtained, the catheter was advanced into the ascites, and the needle removed. 

10. The catheter was connected to wall suction.

11. A sample of ascitic fluid was sent to the lab.

12. A total of [ ] Liters of fluid was removed.

13. All instruments were removed and a sterile dressing placed.

14. The procedure was terminated.

 

Impression:

Successful US guided paracentesis.

[ ] L of fluid removed.

 

Plan or Recommendations:

No recommendations based on findings.

 

 

 

 

Procedure:

Tunneled Peritoneal Catheter Placement / Aspira Placement

 

Date of procedure:

[ ]

 

Indication:

Recurrent ascites for long term drainage and palliation

 

Operators:

Sarel Gaur MD

 

Medications:

Versed IV:  [ ] ml total

Fentanyl IV:  [ ] ml total

 

Contrast:

[ ] ml of Omnipaque intravenous

 

Fluoro time:

[ ] minutes

 

Access site(s):

[Right lower quadrant]

 

Device(s):

Aspira Drainage Catheter

 

Complications:

None

 

Technique and Findings:

 

1. The procedure, possible complications, and use of conscious sedation was explained to the patient patient's family and informed consent was obtained.

2. The patient was brought to the fluoroscopic suite and placed in the supine position with [left] side elevated on the fluoroscopic table. 

3. Nurse monitoring was performed throughout the entire procedure. 

4. Under continuous ultrasound guidance an 18 gauge needle was percutaneously advanced into the right lower quadrant.

5. Under fluoroscopic guidance a J-wire was then advanced into the peritoneal cavity.

6. After dilating the access site, a tunneling device was then used to tunnel a tract anteriorly through which a 16 French Aspira pleural catheter was pulled through.

7. A peel-away sheath was advanced over the wire and into the peritoneal cavity.

8. After the wire was removed the catheter was then advanced through the peel-away sheath and into the peritoneal cavity.

9. The external end of the catheter was then connected to low suction and [1500] cc of [ascitic] fluid was drained.

10. The catheter was then secured with 0-0 Ethilon suture material.

11. A sterile dressing was applied and the patient was transported back to the floor in stable condition.   

 

Impression:

Successful placement of a tunneled cuffed peritoneal drainage catheter, as above.

 

Plan or Recommendations:

Tunneled peritoneal drainage catheter is ready for use.  

 

 

 

 

Procedure:

Tunneled Pleural Catheter Placement / Aspira Placement / PleurX Placement

 

Date of procedure:

[ ]

 

Indication:

Malignant Pleural Effusion for long term drainage and palliation

 

Operators:

Sarel Gaur MD

 

Medications:

Versed IV:  [ ] ml total

Fentanyl IV:  [ ] ml total

 

Contrast:

[ ] ml of Omnipaque intravenous

 

Fluoro time:

[ ] minutes

 

Access site(s):

[Left] anterolateral thorax

 

Device(s):

Aspira Drainage Catheter

 

Complications:

None

 

Technique and Findings:

 

1. The procedure, possible complications, and use of conscious sedation was explained to the patient and patient's family and informed consent was obtained.

2. The patient was brought to the fluoroscopic suite and placed in the supine position with [left] side elevated on the fluoroscopic table. 

3. Nurse monitoring was performed throughout the entire procedure. 

4. Under continuous ultrasound guidance an 18 gauge needle was percutaneously advanced into the left antero-lateral chest.

5. Under fluoroscopic guidance a J-wire was then advanced into the left pleural cavity.

6. After dilating the access site, a tunneling device was then used to tunnel a tract anteriorly through which a 16 French Aspira pleural catheter was pulled through.

7. A peel-away sheath was advanced over the wire and into the left pleural cavity.

8. After the wire was removed the catheter was then advanced through the peel-away sheath and into the left pleural cavity.

9. The external end of the catheter was then connected to low suction and [1500] cc of [serosanguineous] fluid was drained.

10. The catheter was then secured with 0-0 Ethilon suture material.

11. A sterile dressing was applied and the patient was transported back to the floor in stable condition.   

 

Impression:

Successful placement of a left tunneled cuffed pleural catheter, as above.

 

Plan or Recommendations:

Tunneled, cuffed Pleural catheter is ready for use.  

 

------------------

Procedure:

Thoracentesis / Pleural Aspiration

 

Date of procedure:

[ ]

 

Indication:

Pleural Effusion for drainage

 

Operators:

Sarel Gaur MD

 

Medications:

Versed IV:  [ ] ml total

Fentanyl IV:  [ ] ml total

 

Contrast:

[ ] ml of Omnipaque intravenous

 

Fluoro time:

[ ] minutes

 

Access site(s):

[Left] posterolateral thorax

 

Device(s):

5F, 7 cm Yueh Catheter Needle

 

Complications:

None

 

Technique and Findings:

 

1. Limited ultrasound of the left chest was performed localization purposes.

2. The ultrasound demonstrated a [moderate left effusion. ]

3. A hard copy image was stored in the patient's records.

4. Following sterile preparation and draping using standard aseptic technique after local lidocaine infusion, the 5F, 7cm Yueh Catheter Needle was advanced into the fluid under constant ultrasound guidance

5. When satisfactory position was obtained, the catheter was pushed forward and the needle removed

6. Thoracentesisi was performed with removal of approximately [1000 cc] of [serous] fluid.

7. All instruments were removed.

8. Sterile dressing was placed.

9. The procedure was terminated.

 

Impression:

Successful aspiration of the left pleural cavity, as above.

 

Plan or Recommendations:

Removal of [ ] cc of fluid.

Care as per primary team.  

 

------------

Procedure:

Pleural Drainage Catheter Placement / Chest Tube Placement

 

Date of procedure:

[ ]

 

Indication:

Pleural Effusion for drainage

 

Operators:

Sarel Gaur MD

 

Medications:

Versed IV:  [ ] ml total

Fentanyl IV:  [ ] ml total

 

Contrast:

[ ] ml of Omnipaque intravenous

 

Fluoro time:

[ ] minutes

 

Access site(s):

[Left] posterolateral thorax

 

Device(s):

8 French Cook Multipurpose Drainage Catheter

 

Complications:

None

 

Technique and Findings:

 

1. Risks, benefits, and alternatives were discussed and informed consent was obtained. 

2. The patient was brought to examination room, and seated in the stretcher.

3. [The left] pleural effusion was identified under ultrasound. 

4. The skin was marked, prepped with 2 percent chlorhexidine solution and draped.

5. 1 percent lidocaine provided local anesthesia.

6. Under constant ultrasound guidance, the pleural fluid was accessed with a  5F, 7cm Yueh Catheter-needle.

7. When the fluid was encountered, the catheter was pushed forward and the needle removed

8. A short Amplatz wire was placed through the catheter and coiled into the pleural cavity.

9. The catheter was removed and the drainage catheter was advanced over the Amplatz.

10. The wire and inner stiffener were removed and the catheter was pigtailed into the pleural fluid.

11. A sample of fluid was aspirated and sent to the laboratory for analysis.

12. The pleural drain was attached to a pleurEvac set.

13. The catheter was secured to the skin using 0 silk suture and a sterile airtight dressing was placed. 

14. Procedure was terminated.

 

Impression:

Successful placement of a pleural drainage catheter (Chest tube) to the left pleural cavity, as above.

 

Plan or Recommendations:

Catheter and dressing care

 

Abscess Catheter Fluoroscopic Check and Upsize

 

Date of procedure:

[ ]

 

Indication:

Optimize drainage of collection

 

Operators:

Sarel Gaur MD

 

Medications:

Versed IV:  [ ] ml total

Fentanyl IV:  [ ] ml total

 

Contrast:

[ ] ml of Omnipaque intraluminal

  

Access site(s):

Abdomen

 

Device(s):

8 French multipurpose locking pigtail catheter, pre-existing

 

Complications:

None

 

Technique and Findings:

 

1.     Informed Consent was obtained.

2.     Patient was brought to the IR suite and placed supine on the table.

3.     RN was monitoring vital signs throughout.  IV sedation was utilized.

4.     A Scout Fluoroscopic image was obtained

5.     Contrast was infused through the existing catheter and monitored fluoroscopically

6.     An Amplatz wire was advanced into the catheter.

7.     The catheter was removed.

8.     A new [ ] French catheter was advanced over the wire and pigtailed into the collection

9.     A sterile dressing was placed.

10.  The procedure was terminated and the patient was sent back to the holding area.

 

Impression:

Successful upsizing of the drainage catheter, now [ ] French.

 

Plan or Recommendations:

Please flush the catheter qday with 5 cc of sterile saline.  A fluoroscopic drain check can be obtained within 3-5 days.