Pleur-X Catheter Placement
For patients with lung cancer who are undergoing treatment, it is common for fluid to build up in the chest cavity. This fluid build up is painful and potentially harmful, thus requiring draining the chest cavity. This is called a pleural effusion.
A Pleur-X catheter is a medical device that can be placed so that the patient at home can manage their own pleural effusion, rather than making numerous trips for drainage of the pleural effusion in the hospital.
Using imaging guidance, an interventional radiologist can place a Pleur-X catheter at the proper stage of treatment to simplify the home care for this solution.
Fistulograms are useful procedures for doctors treating patients with kidney disease. A dialysis fistulogram offers a detailed view of the patient’s access for dialysis, which may be a shunt or a fistula. Using a fistulogram, an interventional radiologist will be able to detect the location of narrowing or blockage. These can be treated with balloon dilation or stenting to improve flow.
Interventional radiologists also place hemodialysis catheters for kidney disease patients. A hemodialysis catheter provides direct access to the blood stream which is critical to dialysis treatment for patients whose kidneys have failed. As the body offers few access points for a hemodialysis catheter, an interventional radiologist’s training in this area is often vital.
Guided by ultrasound, an interventional radiologist may insert a PICC line. A PICC line is a useful venous line for gaining access to the circulatory system. LIke other central lines that are placed into the body during procedures, a PICC line tip goes to a blood vessel near the heart. A PICC line is distinguishable in that it starts in one of the body’s extremities, usually in the upper arm. As this is the case, the ultrasound allows the interventional radiologist the ability to visualize the large, deep blood vessels in the arm for the PICC catheter’s placement.
This skill is also used in the placement of a port-a-catheter and tunneled central lines. A port-a-catheter allows easy access to the circulatory system for patients with ongoing treatments such as cancer treatments when many blood samples and IV medications are used. A tunneled central line is a central line into the circulatory system like a PICC line. It’s distinguishing factor is that it is placed through an incision, tunneled underneath the skin(thus the name) and then fed into a vein in the neck leading to the superior vena cava. Tunneling under the skin allows the line to be used for a longer length of time.
Ultrasound/CT Guided Abscess Drainage
An abscess is a fairly common condition in which a collection of infected fluid forms within the body. An abscess will cause a patient to experience fever, chills and localized pain. An imaging test, typically a CT scan or an ultrasound can identify and assist with diagnosing an abscess. The doctor may recommend a percutaneous abscess drainage. This procedure is a minimally invasive therapy that is effective in draining abscesses.
A percutaneous abscess drainage is performed under local anesthesia and usually with IV conscious sedation. Using CT or Ultrasound guidance, through a small nick in the skin, the interventional radiologist inserts a thin needle into the abscess to drain the infected fluid. Usually a small drainage tube is left in place to completely drain the abscess fluid. Occasionally, abscesses that cannot be treated by percutaneous drainage may require surgical drainage in the operating room.
The procedure usually takes approximately 20 minutes, although the abscess may continue to drain through the drainage tube for several days after the procedure.
IVC Filter Placement
Deep vein thrombosis describes a condition in which blood clots form in the deep veins, usually in the legs. A pulmonary embolus occurs when clots are carried through the heart and to the lungs through the circulation. When the use of anti-clotting or blood-thinning agents is not indicated for the patient, placing a filter into a main vein such ass the inferior vena cava can protect the heart and lungs from such clots.
To place an IVC filter, an interventional radiologist will use imaging technologies such as ultrasound and real-time fluoroscopy to accurately place a filter into the inferior vena cava. The filter is deployed through a catheter into a safe location from which it can trap free-floating clots. Access for this procedure is usually from a vein in the neck or groin.
Most IVC filters currently used can be easily removed by the interventional radiologist after the threat of clotting has past or left in place permanently depending on the patient’s history. These permanent designs are usually safe from movement by any magnetic resonance imaging equipment.
An IVC filter placement or removal can be performed as an outpatient or inpatient procedure and are typically performed under local anesthetic. The procedure takes approximately 30 minutes to perform.
Gastrostomy Tube Placement
There are numerous reasons why a patient might require a gastrostomy tube, or what is commonly known as a feeding tube. Patients who cannot swallow for a variety of reasons, patients who cannot ingest enough food to stay healthy such as a comatose patient, patients who breathe in food while they eat and babies with birth defects of the mouth, esophagus or stomach all might require a gastrostomy tube.
Gastrostomy tubes may be required for a short period of time or even permanently. Interventional radiologists typically place G-tubes utilizing ultrasound and real-time X-ray guidance, as well as IV conscious sedation and local anesthetics. This procedure usually takes less than an hour.
Nephrostomy Tube Placement/Ureteral Stent Placement
Renal or urinary tract obstruction can be caused by several conditions and should not be ignored. Typical symptoms include but are not limited to abdominal pain, nausea, fever and vomiting. Not only is the build up of urine painful and potentially toxic, any conditions causing obstructions should be evaluated by a doctor immediately. In these cases, it is often necessary to use a nephrostomy tube to gain access to the upper urinary tract. Typically, an interventional radiologist will use ultrasound guidance with real-time X-ray guidance to place a drainage catheter through a nick in the skin directly into the urine collecting system in the kidney. The urine can then drain out of the body via the nephrostomy tube since it can’t drain normally through the ureter (normal tube through which urine passes from each kidney to the bladder) to the bladder. Contrast injected into the nephrostomy tube can help diagnose the location and type of obstruction of the ureter.
Sometimes for kidney stone patients, a ureteral stent can be used to assist in the drainage of urine around the stone (or calculi) on a temporary basis. A ureteral stent is placed during surgery by a urologist or through a nephrostomy tube access by an interventional radiologist. The stent from the kidney to the bladder is usually removed via the patient’s urethra from below with the use of a cystoscope (a small camera inserted into the urethra which can grasp the stent.
Biliary Tube Placement
When a patient has a blockage of the common bile duct of the liver there is a need to drain the bile. Symptoms of biliary obstruction are jaundice (skin turning yellow) and itching. Conditions that might be the cause of a bile blockage are a mass in the liver or pancreas that causes pressure on the common bile duct or a stone from the gallbladder that obstructs the common bile duct.
Imaging technology such as ultrasound and real-time X-ray are used in this inpatient procedure to guide the biliary tube through a nick in the skin, into the bile ducts in the liver, across the stenosis or obstruction of the common bile duct and finally into the small bowel ( where the bile normally drains). This tube allows the bile to drain into the small bowel as well as externally into a bag outside of the body, thus relieving the build up of bile in the liver.
Transjugular Intrahepatic Portosystemic Shunt (TIPS)
Patients with severe liver disease may experience high blood pressure in the portal venous system. This is a result of the damaged liver becoming incapable of processing blood from the bowels. A natural response to this condition is for the body to reroute circulation through more fragile veins causing increased size of the veins of the stomach, esophagus and spleen with increased risk of bleeding and accumulation of fluid in the abdomen and chest.
A minimally invasive procedure to relieve this condition is a transjugular intrahepatic portosystemic shunt (TIPS). A TIPS diverts blood from the congested veins into the main venous system. Using ultrasound and real-time X-ray, an interventional radiologist can create a shunt within the liver to drain off blood. The stent supports the connection from the portal vein system to the main venous system, thus reducing the portal venous pressure.
Embolization for Bleeding
When patients experience excessive bleeding which does not respond to traditional treatment such as cautery for nosebleeds or more invasive surgery for bleeding from a spleen, liver or kidney, embolization may be the best solution. Embolization is a minimally invasive surgery performed by an interventional radiologist that introduces a treatment that temporarily or permanently blocks blood flow in a vessel depending on the site of bleeding.
A small catheter is threaded inside the blood vessels to the site of bleeding, using real-time X-ray. Different materials such as a metallic coil, particle or gelfoam is then released in the vessel to stop the bleeding.
Venous access in patients with difficult venous access
Some conditions make it difficult to create IV access (intravenous access) to the circulatory system. These conditions include obesity, IV drug abuse, chronic illnesses, blood vessel disorders and low blood volume.
Ultrasound guidance is utilized for all of our venous access cases.