Modern medicine relies heavily on radiology for the development of various treatment methods. Complex conditions such as abscess management can be handled more effectively with radiological techniques. The percutaneous drainage procedure offers a minimally invasive approach, promising patients less pain and a faster recovery process. This procedure is performed using imaging techniques such as computed tomography or ultrasound.
| Things You Need to Know About Drainage Therapy | |
| Definition | The placement of a catheter or tube to prevent fluid accumulation in the body or to drain existing fluid collections. |
| Indications | Abscess, pleural effusion, hydrothorax, pericardial effusion, intra-abdominal fluid accumulation (ascites), biliary drainage, pancreatic pseudocyst. |
| Contraindications | Bleeding disorders, risk of spreading active infection at the drainage site, anatomical challenges. |
| Pre-procedure Preparation | Blood tests, imaging studies (ultrasound, CT, MRI), infection control, bleeding risk assessment, requirement for fasting before the procedure. |
| Procedure Duration | Typically between 30 minutes and 1 hour. |
| Type of Anesthesia | Local anesthesia and sedation. |
| Procedure Steps | 1. Identify and mark the target area 2. Apply local anesthesia 3. Puncture the skin and subcutaneous tissues 4. Insert the catheter or tube 5. Confirm correct position and secure it 6. Initiate drainage |
| Complications | Infection, bleeding, organ injury, catheter blockage or displacement, surrounding tissue damage. |
| Recovery Time | Typically a few days to several weeks; drainage duration and catheter dwell time depend on the disease type and patient’s condition. |
| Success Rate | High; symptom relief through successful fluid drainage. |
| Alternative Treatments | Medication (diuretics), surgical drainage, endoscopic procedures, conservative therapy aside from percutaneous drainage. |
Interventional Radiology / Interventional Neuroradiology
Prof. Dr. Özgür KILIÇKESMEZ
Scope of Drainage Therapy
Drainage therapy is a frequently used method in medicine. This procedure is a key technique in interventional radiology. Percutaneous drainage is performed under the guidance of imaging technologies, offering a less invasive treatment. The success of the therapy largely depends on the site of drainage and the nature of the infection. Therefore, the way the procedure is applied is tailored to the patient’s condition.
- This method, preferred by interventional radiology specialists, is both safe and effective.
- The placed catheter or drain evacuates fluid collections such as abscesses, helping to control the infection.
Imaging methods used during the procedure enhance the accuracy and safety of the treatment. Ultrasound and computed tomography are the most commonly employed techniques in this process. Both allow the physician to place the drain precisely, reducing the invasiveness of the intervention.
Anatomy and Physiology in Drainage Therapy
An abscess forms as a direct response to the activity of infectious microorganisms in the body. Pus accumulates at the infection site, creating a wall around the infected tissues. The pus contains dead cells and bacteria. Abscesses can occur in almost any region of the human body. The following areas are particularly prone to abscess formation:
- Skin and soft tissues
- Sigmoid colon in diverticular abscesses
- Right lower quadrant following appendicitis
Each region differs in characteristics and treatment approaches. Subcutaneous abscesses are generally more superficial and more accessible to treatment. Abscesses in internal organs require deeper treatment methods. *We recommend filling out all fields so we can respond in the best possible way.
When to Apply Drainage Therapy
Percutaneous catheter use is preferred in certain conditions. This technique is particularly effective for specific types of abscesses. These include abscesses with various features, as well as cases with unclear clinical diagnoses or resistance to standard medical treatments.
- Multiple and/or multiloculated abscesses: These structures can be difficult to treat with simple methods.
- Abscesses with potential enteric communication: Indicates possible connection to the gastrointestinal system.
- Abscesses larger than 3 cm: Require more careful management due to their size.
- Uncertain clinical diagnoses: Imaging techniques can aid in diagnosis.
- Failure of medical treatment: When conventional therapies prove insufficient.
- Intolerance to medical treatment: Due to patient intolerance or adverse effects.
When Drainage Therapy Should Not Be Applied
Percutaneous catheter placement may not be suitable in some cases. The contraindications for this procedure include factors that directly affect safety and efficacy, increasing risks during and after the intervention. The following are contraindications for percutaneous drainage:
- Uncorrectable coagulopathy, significantly increasing bleeding risk and leading to complications.
- Lack of safe percutaneous access, meaning no suitable entry points for a safe procedure.
- Inability of the patient to comply with the procedure, due to psychological or physical reasons, negatively affecting success.
- Insufficient patient understanding or lack of informed consent, as the patient must comprehend and agree to the procedure and its outcomes.
- Lesions typically smaller than 3 cm, as these do not provide enough space for necessary instruments.
Equipment Required for Drainage Therapy
Success in drainage therapy is closely linked to the correct use of equipment. Catheter selection is critical for an effective drainage procedure and varies based on the nature of the fluid:
- Catheters of 8 to 10 French are sufficient for serous fluids.
- Catheters of 12 French or larger are preferred for bloody or viscous fluids.
The procedure must be performed under aseptic conditions, requiring a sterile field. Necessary materials include:
- Sterile drainage bag
- Betadine solution
- Fenestrated drape
A scalpel is used to open the area for drainage. During the procedure, the patient’s vital signs must be continuously monitored via a cardiac monitor, covering blood pressure, pulse, and oxygen saturation. All equipment is chosen according to the nature of the procedure and the physician’s preference, and imaging methods such as ultrasound or CT may be used throughout.
Preoperative Steps for Drainage Therapy
The success of percutaneous drainage therapy depends on meticulous pre-procedure preparation. During this process, radiologists perform a detailed assessment of the patient’s health. The first step is obtaining consent from the patient or their legal representative. Next, various tests and analyses that reflect the patient’s overall health are performed. These preparations are essential for patient safety and preventing potential complications.
- Obtain patient or representative consent.
- Perform complete blood count and important lab tests such as PT/INR.
- Ensure platelet count is at least 50,000/µL.
- Maintain international normalized ratio (INR) below 1.5.
- Ensure serum hemoglobin level above 9.0 g/dL.
- Consider broad-spectrum antibiotics pre-procedure for high-risk cases.
Technical Options and Procedural Techniques
Percutaneous drainage procedures for abscess treatment use two main methods: the Seldinger and trocar techniques. The choice depends on the abscess’s location and size.
Seldinger technique:
- Ideal for small and deep abscesses.
- Preferred in hard-to-reach and high-risk areas.
- Access is gained with a fine needle, then exchanged for a thicker wire.
Trocar technique:
- Suitable for large and superficial abscesses.
- Aspirates abscess contents with a needle.
- Accesses the collection directly with a coaxial catheter.
Both techniques are performed under sterile conditions and local anesthesia. The patient is monitored throughout, and sedation can be administered if necessary. Materials and procedural steps are carefully selected based on abscess characteristics and the treatment area’s sensitivity.
After catheter placement, the infected fluid is directed into a drainage bag. Negative-pressure collection systems aid efficient fluid removal. The catheter remains in place until the abscess is fully drained, which can take several days, after which it is safely removed.
Possible Complications of Drainage Therapy
Complications during drainage procedures vary by patient condition and treatment site. The most common issues include pain, infection, and bleeding. Careful preparation can prevent such complications and enhance post-procedure safety. Pre-procedure planning minimizes problems such as incorrect catheter placement, and correct catheter choice is crucial.
- Sepsis
- Inadequate drainage
- Incorrect catheter placement
- Bowel injury
- Bleeding
- Pneumothorax
- Hemothorax
- Cardiorespiratory arrest
- Peritonitis
Each of these issues requires special attention during and after the procedure. Bacteremia and septic reactions can lead to serious health problems. Rapid and effective intervention is essential. Patients showing significant symptoms post-procedure should be treated immediately and, if necessary, transferred to the intensive care unit. Aggressive fluid resuscitation and antibiotic therapy are key to managing these complications.
Critical Role of the Treatment
The percutaneous drainage method plays a critical role in abscess treatment. This minimally invasive technique allows effective drainage of deep abscesses, significantly accelerating the patient’s recovery. Patients avoid general anesthesia, reducing hospital stays and care costs. Additional benefits of percutaneous drainage include:
- Reduced pain sensation in patients.
- Accelerated recovery process.
- Lower infection risk.
Antibiotic use may increase during treatment. In most cases, incision and drainage are sufficient, but in critical cases, antibiotic therapy may be necessary. Systemic symptom patients especially require antibiotics. Appropriate antibiotic selection considers the patient’s history and risk factors:
- Diabetes
- History of MRSA
- Intravenous drug use
Optimizing Treatment Outcomes through Team Collaboration
Coordination of patient care is crucial during abscess treatment. Patients typically first consult primary care providers. Based on evaluation, they are referred to specialists for specific treatments depending on abscess size and location. Detailed transfer of patient information is essential throughout this process. This information transfer should include:
- The patient’s current health status and history
- Laboratory tests and other objective data
- A detailed summary of the patient’s complaints and symptoms
Effective communication ensures timely and appropriate interventions at every stage of treatment. It speeds up the process and helps prevent potential complications. It is also important that patients have complete information to utilize home health services. Strong communication at every step supports patient-centered care and increases treatment success.“`
Prof. Dr. Özgür Kılıçkesmez graduated from Cerrahpaşa Medical Faculty in 1997. He completed his specialization at Istanbul Education and Research Hospital. He received training in interventional radiology and oncology in London. He founded the interventional radiology department at Istanbul Çam and Sakura City Hospital and became a professor in 2020. He holds many international awards and certificates, has over 150 scientific publications, and has been cited more than 1500 times. He is currently working at Medicana Ataköy Hospital.
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