Fluid Management
Various diseases can result in fluid collecting where it does not belong. Depending on where this fluid is located, it can cause pain/discomfort, shortness of breath, or even become infected.
For these reasons, and many others, some doctors and patients may want that fluid removed. Using image guidance, we Interventional Radiologists at HRA can help relieve the symptoms from pathologic fluid accumulation.
Abscess Drain Placement
When a collection of fluid becomes infected, it is known as an abscess. Abscesses can sometimes be treated with antibiotics alone; however, often the antibiotics cannot get deep enough into the collection to resolve the infection. In these cases, patients may require drainage, which can be done with surgery or less invasively, through the skin with a needle, by an interventional radiologist.
Under imaging guidance, a safe path from the patient’s skin to the collection is identified. After numbing the area, a small needle is advanced along that path into the collection. A wire is advanced via the needle and looped within the collection. The needle is exchanged over the wire for a hollow tube and the wire is removed. This hollow tube (i.e. the drain) is left in place, allowing the fluid to drain and the infection to resolve.
Depending on the location of the collection, this procedure has a mild to moderate risk of bleeding, infection, and damage to nearby organs. Patients should refrain from eating and drinking for at least 6 hours prior to the procedure in order that they may receive medications to help them relax. This procedure can be performed on both inpatients and outpatients, who can return to their room or home after a short observation.
Abscess Drain Replacement
In some cases, even after a drain is placed a portion of the collection remains or the collection reaccumulates. In these cases, the patient may need to have their drain replaced, repositioned, and/or increased in size.
This is typically performed under x-ray guidance. After numbing the area around the indwelling drain, a wire is advanced through the old catheter. The old catheter is removed, the wire is directed to the undrained portion of the collection, a new drain is placed over the wire, and the wire is removed.
This procedure has low risk of bleeding, infection, and damage to adjacent structures. Patients will need to abstain from eating or drinking for at least 6 hours prior to the procedure so that they may receive medications to help them relax. It can be performed for both inpatients and outpatients, who usually need to stay for about an hour after the procedure before returning to their room/home.
Abscess Drain Removal
In most cases, after a drain is placed into an abscess, the fluid drains, and the infection resolves quickly. After confirming that the collection/infection are gone, a doctor can remove the tube by releasing the holding suture/fixation device, cutting the end of the tube, and gently pulling it out.
This procedure has very low risks and only takes a few minutes at bedside. Patients do not need to refrain from eating or drinking prior to drain removal. It can be performed for both inpatients and outpatients, who usually need to stay for a few minutes of monitoring before returning to their room/home.
Paracentesis
When fluid builds up in the abdomen, it is called ascites. Ascites can cause abdominal swelling, pain, shortness of breath, and difficulty eating.
In order to figure out why fluid is building up and/or to treat the above symptoms, the fluid can be removed. Under real-time ultrasound guidance, a pocket of fluid is identified. Then, the overlying skin and soft tissues are numbed with an injection of numbing medication. Finally, a small needle and catheter are introduced into the fluid. The fluid is removed, and samples may be submitted for laboratory evaluation.
The procedure has a low risk of bleeding, infection, and damage to nearby organs. We perform this procedure for both inpatients and outpatients. Inpatients usually can return to their room immediately after the procedure. Outpatients also usually can return home immediately after the procedure.
Thoracentesis
When fluid builds up in the chest, in the space surrounding the lung, it is called a pleural effusion. Pleural effusions can cause pain and shortness of breath.
In order to figure out why fluid is building up and/or to treat the above symptoms, the fluid can be removed. Under real-time ultrasound guidance, a pocket of fluid is identified. Then, the overlying skin and soft tissues are numbed with an injection of numbing medication. Finally, a small needle and catheter are introduced into the fluid. The fluid is removed, and samples may be submitted for laboratory evaluation.
The procedure has a low risk of bleeding, infection, and damage to nearby organs. In particular, it has a small, but real risk of a pneumothorax, which is when air fills the space between the lung and the chest wall. In order to evaluation for this complication, we usually perform a chest x-ray after the procedure is finished. We perform this procedure for both inpatients and outpatients. Inpatients usually can return to their room immediately after the procedure. Outpatients also usually can return home immediately after the procedure.
Pleur-X Catheter Placement
Recurrent ascites (see above) or pleural effusions (see above) that cause significant symptoms are typically treated with medications and repeat drainage procedures. For the right type of patient, in order to make removing fluid easier and more convenient, we can place a catheter into the area where the fluid builds up and then the patient can remove fluid at home with special vacuum bottles.
The process is very similar to the paracentesis/thoracentesis procedure above. Under real-time ultrasound guidance, a pocket of fluid is identified. Then, the overlying skin and soft tissues are numbed with an injection of numbing medication. A small needle is introduced into the fluid. A wire is advanced via this needle into the fluid. The needle is exchanged over the wire for a hollow tube. A catheter is tunneled under the skin and fed through the hollow tube into the fluid. The hollow tube is removed. The patient can then use the catheter to remove the fluid at home, whenever they have symptoms.
The procedure has a low risk of bleeding, infection, and damage to nearby organs. We perform this procedure for both inpatients and outpatients. Inpatients usually can return to their room immediately after the procedure. Outpatients also usually can return home immediately after the procedure.
