Interventional radiology2

1. RESULTS OF BIOPSY+ve diagnosis between 70 et 100%.Least performance in lymphoma
3. STERILE MATERIEL Drainage DIRECT METHOD SELDINGER TECHNIQUE 1 drain Add 1 Fixation system 1 Puncture needle 1 3-way connector 1 guidewire 1 tubular connection 1 dilator 1 sterile urine bagPotentially suture kit and needle holder
4. Direct Puncture
5. Seldinger Technique
6. DRAINAGE Fine needle allow to precise the nature of the fluid to drain. And to adapt caliber of drain Never empty before draining
7. INTERVENTIONAL 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. Technician may help for gain and depth adjustment of the USmachine, 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)
8. INTERVENTIONNELCollection Drain positioning drain
9. DRAINAGE 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
10. AFTER 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.
11. FOLLOW-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) If persistance : search for fistula
12. AFTER INTERVENTIONAL PROCEDURE Verification of discharge flow in the drain. Follow-up: Emptying – flush with10 cc normal saline with re-aspiration – AB IV : no flushing Decreasing discharge Clamping Test after follow-up US and clinical improvement.
13. Interventional Ultrasound PATIENT Skin cleaning in 4 steps – detersion with cleaning solution – Rince with Sodium Chloride – Dry with sterile gauze – Disinfection with antiseptic solutionIn case of wound:Cover the probe with sterile protectionCover the lesion with transparent sterile dressing
14. INTERVENTIONAL RADIOLOGY CT Advantagesanatomy•Content• DisadvantagesLong•Axial only or oblique axial (limited)•Mobility•
15. INTERVENTIONAL RADIOLOGYUS/CT Position /Gantry Dimension• Laser beam• Monitor in the room• IV (ureter, necrosis)• Cooperation (apnea)• Needle guide•
16. INTERVENTIONAL RADIOLOGYUS/CT Needle extremity (same apnea)• Coaxial System (No of samples)•
18. INTERVENTIONAL RADIOLOGY US/CT Liver US Rules: Pass through normal liver Biopsy of the lesion’s wall Needle retrieval during blocked expiration Ambulatory (outpatient) Prevent shoulder pain after (20%)
19. …… Breast cancer – ovarian masses Peritoneal carcinomatosis with – ascites (cytology non contributive) origin : type de cancer? –
20. INTERVENTIONAL RADIOLOGY US/CT Pancreas CT or US Rules: Use the technique that best shows the lesion Avois gastric puncture, otherwise 20G aspiration always sufficient If suspected multicystic lesion avoid colon puncture Risks: Hemorrhage by vascular injury Acute pancréatitis if normal pancreas is injured Passing through normal liver
21. US/CT
22. US/CT

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