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Management of visceral interventional radiology catheters: a troubleshooting guide for interventional radiologists
Michael M Maher1, Susan Kealey, Ann McNamara
1Department of Radiology, St Vincent's University Hospital, Dublin, Ireland.
Insights
Managing visceral interventional radiology catheters involves secure fixation techniques to prevent dislodgement. Strategies for safe exchange and removal are crucial for patient care and successful outcomes.
Area of Science:
- Interventional Radiology
- Medical Device Management
Background:
- Visceral interventional radiology catheters present challenges during exchange or removal.
- Complications include guide wire exit, blockage, pigtail issues, and catheter fracture.
Purpose of the Study:
- To discuss challenges in visceral catheter management.
- To recommend techniques for secure catheter fixation and safe removal.
- To outline strategies for catheter replacement and repositioning.
Main Methods:
- Review of common difficulties encountered with visceral catheters.
- Discussion of secure catheter fixation methods.
- Consideration of imaging techniques like tractography for mature tract assessment.
Main Results:
- Secure catheter fixation without direct skin puncture is recommended.
- Catheter replacement without repuncture may be possible if dislodged.
- Tractography is valuable for catheters requiring mature tracts (e.g., cholecystostomy).
Conclusions:
- Effective management of visceral catheters requires attention to fixation, exchange, and removal.
- Proper technique and assessment (e.g., tractography) are vital for successful outcomes.
- Catheter repositioning or addition may be necessary for persistent abscess cavities.
Abstract:
Visceral interventional radiology catheters can be difficult to exchange or remove for a variety of reasons. These reasons include exit of the guide wire through the side holes of the catheter, blockage of the catheter, difficulty unlocking the pigtail, retention of the string after catheter removal, migration of the string ahead of the guide wire, catheter fracture, and snaring of an adjacent stent by the pigtail. Secure fixation of the catheter to the skin is important. A technique that allows secure fixation without direct puncture and suturing of the catheter to the skin is recommended. If a catheter falls out or is inadvertently removed, access can occasionally be regained and the catheter can be replaced without repuncture. The timing of catheter removal is based on the clinical condition of the patient and the daily output from the catheter. "Tractography" is a useful study before removal of any catheter that requires a mature tract for removal, particularly cholecystostomy catheters and transpleural catheters. In biliary catheter exchange, the most vital issue is the position of the side holes of the catheter. If an abscess cavity remains large after catheter drainage, the catheter can be repositioned or a second catheter can be placed.