There
are 4 types of NonVascular Procedures that a patient might have:
1.
Drainage Procedures
2.
Feeding tubes
3.
Radiofrequency ablation of tumors (RFA)
4.
Biopsy
CHOLECYSTOSTOMY
(GALLBLADDER DRAINAGE TUBE)
General
Information:
- The
gallbladder is a reservoir for bile which empties to assist in digestion
following a fatty meal. It is possible for gallstones to become lodged
in the bile duct and prevent the gallbladder from emptying. This can
cause right upper abdominal pain and result in a severe infection
called “cholecystitis.” This diagnosis is usually made
using ultrasound in combination with a clinical history and examination.
- Ultimately,
removing the gallbladder (“cholecystectomy”) is required
however some patients may be too ill to undergo a major surgical procedure
due to generally poor health or because of the severity of the acute
infection. In these instances a percutaneous cholecystostomy tube
may be necessary to drain the infected gallbladder. Draining the gallbladder
will control the infection and stabilize the patient at which time
surgery may be performed more safely.
What
happens during the procedure?
- Conscious
sedation is provided just prior to starting the procedure.
- Patients
will lie flat on the x-ray table. The skin overlying the right side
of the abdomen is cleaned with a betadine solution after which sterile
drapes are placed around the area.
- Ultrasound
is used to visualize the gallbladder and lidocaine local anesthesia
is injected into the overlying skin. A needle is used to puncture
and introduce a wire into the gallbladder. The track through the skin
is sequentially dilated using tapered plastic tubes called “dilators.”
This will make the track large enough, (approximately 3-4mm,) for
placing the cholecystostomy tube. The tube is sutured to the skin
and connected to a drainage bag which can be emptied as needed.
- This
procedure takes approx 45 minutes.
What
happens after the procedure?
- Following
placement of the cholecystostomy tube patients will continue to receive
intravenous antibiotics. Patients are also monitored for signs of
the infection spreading into the abdominal cavity “peritonitis.”
- Depending
on various circumstances, the tube may be removed in several weeks
and require no further therapy or, more frequently, a cholecystectomy
may be necessary. Rarely, in patients who have multiple complex medical
problems, the cholecystostomy tube is maintained indefinitely.
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BILIARY
DRAINS/STENTS
General
Information:
- The
bile ducts can become obstructed or narrowed-- most commonly because
of tumor or stones. If bile cannot be excreted, patients may become
jaundice. In addition to yellowing of the skin it can make patients
very itchy. Depending on the location of the blockage, it may be necessary
to drain the bile either by placing a tube into the gallbladder or
directly through the liver. Alternatively, the bile ducts may be drained
endoscopically. If tumor is present, a stent may be needed to keep
the ducts open.
What
happens during the procedure?
- Conscious
sedation is provided prior to
starting the procedure.
- Patients
will lie flat on the x-ray table. The skin overlying the right side
of the abdomen is cleaned with a betadine solution after which sterile
drapes are placed around the area.
- Ultrasound
may be used to visualize the bile ducts and lidocaine local anesthesia
is injected into the overlying skin. A needle is used to puncture
the liver and introduce a wire into the bile ducts. The track through
the skin is sequentially dilated using tapered plastic tubes called
“dilators.” This will make the track large enough, (approximately
3-4mm,) for placing the drainage tube. The tube is sutured to the
skin and the bile drains into a bag which can be emptied as needed.
If the bile duct is narrowed, a balloon may be used to re-open the
duct. A stent may be used to augment balloon dilatation in certain
situations.
- This
procedure takes approx 1-2 hours.
What
happens after the procedure?
- The
biliary drainage catheter is connected to a drainage bag which may
be secured to the leg. Patients may return within 24-48 hours for
a cholangiogram (injection of x-ray dye through the tube.) The tube
needs to be flushed with saline at least 3 times each day so that
it does not become blocked by debris.
- As
the patient’s acute condition stabilizes, additional procedures
may be necessary to restore the natural drainage of bile into the
small intestine. These include placement of stents or removal of stones
from the biliary system.
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DRAINAGE
OF ABSCESS/FLUID COLLECTIONS
General
Information:
- Localized
collections of fluid can collect almost anywhere in the body. This
fluid may be from a primary infection, a complication of surgery,
rupture of hollow organs, cysts, or a host of other sources. If this
fluid collection becomes infected it is called an abscess.
- Cysts
and similar fluid collections may need to be drained because of pressure
exerted upon nearby structures. Abscesses require drainage because
antibiotics cannot enter into the infected area due to lack of blood
supply.
- Sometimes
these collections are drained surgically and other times they may
be drained percutaneously (through a small hole in the skin.)
- Percutaneous
drainages are performed using imaging guidance which may be in the
form of one or more modalities: ultrasound, CT, MRI or fluoroscopy
(live x-rays.)
What
happens during the procedure?
- Conscious
Sedation is
usually provided prior to starting the procedure.
- Patients
will lie flat on the x-ray table. The skin overlying the area of concern
is cleaned with a betadine solution after which sterile drapes are
placed around the planned drainage site.
- One
of the imaging modalities is used to select the best site from which
to approach the area to be drained and lidocaine local anesthesia
is injected into the overlying skin. A needle is used to puncture
the fluid collection/abscess and introduce a wire into the cavity.
The track through the skin is sequentially dilated using tapered plastic
tubes called “dilators.” This will make the track large
enough, (approximately 3-4mm,) for placing the drainage tube. The
tube is sutured to the skin and the fluid drains into a bag which
can be emptied as needed.
- This
procedure takes approx 1 hour.
What
happens after the procedure?
- The
drainage catheter is connected to a bag which may be secured to the
leg. The tube needs to be flushed with saline at least 3 times each
day so that it does not become blocked by debris. Patients continue
to receive antibiotics.
- Patients
are monitored for signs of improvement and as the daily drainage from
the tube subsides it may be removed. If the patient does not improve
as expected further imaging may be necessary which may show the need
to reposition or modify the drainage tube in some way.
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NEPHROSTOMY
TUBE/URETERAL STENT INSERTION
General
Information:
- When
ureter of the kidney becomes blocked, urine backs up and causes increasing
pressure in the kidney. This is not only painful but can damage the
kidney. Blockage of the ureter may be secondary to stones, tumors,
infections or bladder problems.
- The
immediate goal is to drain the urine in the kidney’s collecting
system. This is frequently accomplished by placing a tube (percutaneous
nephrostomy) through the skin into the kidney where the urine collects.
Secondary efforts are directed towards relieving the obstruction.
This may include placement of a thin tube (“stent”) from
the kidney into the bladder by way of the ureter.
What
happens during the procedure?
- Conscious
sedation is usually provided prior to starting the procedure.
- Patients
will lie face down on the x-ray table. The skin overlying the flank
is cleaned with a betadine solution after which sterile drapes are
placed around the planned drainage site.
- Ultrasound
and/or fluoroscopy is used to select the best site from which to approach
the area to be drained and lidocaine local anesthesia is injected
into the overlying skin. A needle is used to puncture the collecting
system and introduce a wire down the ureter. The track through the
skin is sequentially dilated using tapered plastic tubes called “dilators.”
This will make the track large enough, (approximately 3-4mm,) for
placing the nephrostomy tube. The tube is sutured to the skin and
the fluid drains into a bag which can be emptied as needed.
- If
a stent is to be placed, a wire is directed down the ureter ito the
bladder and the stent can be placed over the wire such that one end
is within the bladder and the other end is within the kidney.
- This
procedure takes approx 1 hour.
What
happens after the procedure?
- The
drainage catheter is connected to a bag which may be secured to the
leg. The tube needs to be flushed with saline at least 3 times each
day so that it does not become blocked by debris. Patients usually
require antibiotics as infection is often coexistent.
- Patients
are monitored for signs of improvement and the daily drainage from
the tube is recorded. When the blockage is resolved, the tube is removed.
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FEEDING TUBES
General
Information:
- Feeding
tubes are placed through the skin directly into the gut. They are
typically used in patients who are unable to ingest food by mouth.
In cases of chronic bowel obstruction the tube may be used to drain
secretions and swallowed air from the stomach.
- The
tubes are named for where they are placed. A gastrostomy tube (G-tube)
is placed directly into the stomach. A gastrojejunostomy (G-J tube)
has two channels that split: one ends in the stomach and the other
exits the stomach extending into the jejunum (middle portion of the
small intestine.) A jejunostomy tube (J-tube) is placed directly into
the small intestine.
What
happens during the procedure?
- Conscious
sedation is usually provided prior to starting the procedure.
- Patients
will lie flat on the x-ray table. The skin overlying left upper abdomen
is cleaned with a betadine solution after which sterile drapes are
placed over the abdomen. A small tube is inserted through the patient’s
nose, down the esophagus and into the stomach. Air is used to inflate
the stomach which allows the stomach to be seen using x-rays and pushes
nearby organs away from the path of the planned path of the tube.
- Live
x-ray is used to visualize the stomach and colon and choose the best
site from which to approach the stomach and lidocaine local anesthesia
is injected into the overlying skin. A needle is used to puncture
the stomach and introduce a wire into the stomach. The track through
the skin is sequentially dilated using tapered plastic tubes called
“dilators.” This will make the track large enough, (approximately
7mm,) for placing the gastrostomy tube. A balloon on the end of the
tube is inflated which helps retain the tube in the stomach.
- If
a G-J tube is needed, the jejunal portion of the tube is directed
into the small intestine using fluoroscopy to guide positioning.
- The
same technique is used to place a direct J-tube except the small intestine
is punctured directly.
- This
procedure takes approx 1 hour.
What
happens after the procedure?
- G-tubes
may be used 24 hours following placement. J-tubes can be used when
the patient’s bowel sounds return.
- The
tubes should be flushed with water following each use.
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RADIOFREQUENCY ABLATION OF TUMORS (RFA)
General
Information:
- Radiofrequency
ablatation (RFA) of tumors is an emerging therapy for treating tumors
and tumor metastases. Treatment involves placing a probe into a tumor
using image guidance to ensure proper positioning. The probe delivers
high intensity thermal energy into the tumor and immediate surrounding
tissue. This effectively kills the tumor and a small area of surrounding
tissue.
- This
treatment option is more commonly used in the liver but has been successful
in treating tumors in many other areas such as lung, bone, and kidney.
The procedure may be performed directly through the skin or in the
operating room where the probe is placed directly into the organ during
surgery.
- The
utility of this therapy is limited by the location of the tumor and
its size. However, even if the tumor is too large or is located near
vital structures, RFA may be useful to “debulk” the tumor
and provide relief of symptoms.
What
happens during the procedure?
- Conscious
sedation is usually provided prior to starting the procedure.
- Patients
usually lie flat on a stretcher. The skin overlying the area of interest
is cleaned with a betadine solution after which sterile drapes are
placed around the planned entry site.
- Ultrasound
or CT is used to select the best site from which to approach the tumor
and lidocaine local anesthesia is injected into the overlying skin.
The probe is directed to the tumor using image guidance and energy
is deposited into the tumor for approximately 10 minutes. Often the
probe is repositioned several times and the treatment cycle is repeated
to ensure complete coverage of the target tissue.
- The
probe is removed and patients are usually observed in the hospital
for 24 hours.
- This
procedure takes approx 2 hours.
What
happens after the procedure?
- Patients
usually remain in the hospital overnight for observation and pain
control and go home the next day.
- A
CT scan or MRI is typically obtained 3-6 months following treatment
to assess for signs of residual tumor. Blood tests for tumor marker
levels may also be helpful. Depending on the results, additional treatments
may be recommended.
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BIOPSY
General
Information:
- A
biopsy is a procedure which obtains a sample of tissue for the purpose
of determining its nature (benign or malignant.) The results can then
guide the appropriate choice of treatment.
- Biopsies
may be performed surgically, by direct palpation or using image guidance.
- Image-guided
biopsies involve placing a biopsy needle directly into the abnormality
using CT, ultrasound, MRI or fluoroscopy to ensure sampling of the
appropriate area.
What
happens during the procedure?
- Conscious
sedation may
be provided prior to starting the procedure.
- Patients
usually lie flat on a stretcher or x-ray table. The skin overlying
the area of interest is cleaned with a betadine solution after which
sterile drapes are placed around the planned entry site.
- Usually
ultrasound or CT is used to select the best site from which to approach
the tumor and lidocaine local anesthesia is injected into the overlying
skin. A needle is directed into the abnormality using image guidance
and a sample of the tissue is obtained. Often more than one sample
is obtained to ensure an adequate evaluation of the lesion.
- The
needle is removed and patients are observed for 1-2 hours before going
home.
- This
procedure takes approx 30min - 1 hour.
What
happens after the procedure
- Patients
are observed for 1-2 hours before going home.
- The
biopsy results are usually available through the requesting physician
within 72 hours.
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CONSCIOUS
SEDATION
If
you have been scheduled for a procedure that may cause you some discomfort
or anxiety, the Radiologist may recommend that we administer sedation
to you during your procedure.
This conscious sedation/sedation for the procedure will be administered
to you by a specially trained radiology nurse.
Its purpose is to relax you during your procedure and to reduce
any discomfort that you may experience.
You may or may not be drowsy.
You will remain conscious and able to speak and follow instructions
by the Radiologist throughout your procedure.
You will not be "put to sleep."
The most frequently used medication given for conscious sedation
are Fentanyl and Midazolam. If
you have allergies to either of these medications, please let your doctor
know. The medications will be given to you in an
IV line that will be started prior to you procedure.
The following are instructions to all patients whom may receive conscious
sedation/sedation for procedures;
-
DO NOT eat solid
foods for six hours before your procedure.
- You
may have clear water, black coffee or tea, or apple, cranberry, grape
juices, jello and broth, two hours before your procedure.
-
You may take all of your routine medications with clear
liquids up to two hour before your procedure.
-
If you have been requested to stop taking certain medications
by your doctor, do not take those.
-
If you are a diabetic on insulin, you should consult with your
doctor regarding your insulin dosage for the Morning of your procedure.
- You
must have a responsible adult driver escort you home from the hospital.
A
Radiology nurse will be calling you reviewing these instructions and
able to answer any questions you may have or you can call 802-847-3946
M-F 8:00-4:30pm. If one of us
are not readily available you can leave a message and we will get back
to you.
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