#ACCORDION METHOD TO HER FLUID OUT VERIFICATION#
Seldinger technique can be used for most indications and carries the advantage of verification of successful access into the collection and successful avoidance of adjacent structures prior to the creation of a large-bore tract.
The choice is often based on physician experience, preference, and comfort level. Regardless of the imaging modality used for guidance, two techniques for catheter placement are used: the Seldinger technique and the trocar technique. One of the inherent disadvantages is the inability of US to penetrate extensive overlying soft tissue or air-filled structures such as lung, bowel loops, or gas-filled collections.īecause of the risks of complications such as sepsis, bleeding, and oversedation, abscess drainage should be performed during active monitoring of heart rate, blood pressure, and oxygen saturation. US is usually immediately available, provides excellent visualization of larger and more superficial collections, and provides the best visualization of direct needle advancement, septations, loculations, adjacent vascular structures (via Doppler imaging), and many pelvic collections (via transrectal or transvaginal US).
In addition, CT fluoroscopy promises to increase accuracy and decrease procedure time.ĭespite the advantages of CT, ultrasonography (US) provides several advantages and is the preferred primary modality for specific drainage procedures by many radiologists. As a result, CT is also advantageous for guiding drainage, particularly in cases in which collections are small and deep, in close proximity to vital structures, and located in regions that are difficult to access (e.g., the transgluteal route for pelvic drainage). Computed tomography (CT) is the preferred modality to identify the extent of abscesses and to plan the route of access as distinction of the fluid collection from the adjacent normal structures can be exquisitely enhanced by the administration of oral and intravenous contrast agents. The choice depends on physician preference and comfort as well as anatomic factors such as the size of the collection and its location in relationship to the surrounding structures. Choosing an Imaging Modality for GuidanceĪn appropriate choice of imaging modality for guidance is a critical first step as it provides information regarding feasibility, appropriate technique, and associated risks for the purposes of informed consent and procedural planning.
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