Does seeding of the needle tract occur during routine tumor biopsy? Case reports of tumor spread along the needle tract as a result of percutaneous biopsy are described in the medical literature. Overall, seeding the needle tract is uncommon and the reported rates vary according to organ biopsied. For masses suspected to be hepatocellular carcinoma …
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What are the major complications of image guided PNB? Major complications are defined as those that result in an unplanned increase in the level of care, prolonged hospitalization (in-patients), admission to the hospital for therapy (out-patients), permanent adverse sequelae, and death. The complications of PNB can be stratified as general or organ-specific. Major general complications …
When to remove the drainage catheter? If the catheter output is less than 10 to 20 mL per 24 hours, there are no other reasons for the decreased outputs (e.g., catheter clogged, kinked, or malpositioned), and the patient has clinically improved, the catheter can be removed. Repeat imaging with US, CT, or contrast injection under …
What to suspect if the drainage catheter has persistently elevated outputs? If a catheter has persistently elevated outputs, a sudden increase in drainage, or a change in the composition of the effluent, a fistula should be suspected. Injection of contrast into the catheter under fluoroscopy often demonstrates the fistula, which can be to the gastrointestinal …
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What pharmacologic agents can be injected into septated or viscous abdominal fluid collections to improve drainage? Intracavitary fibrinolysis therapy with tissue plasminogen activator (tPA) can be performed through the drainage catheters to shorten treatment time and improve the clinical course of patients treated with percutaneous drainage catheters. Optimal dosing regimens have not been determined. Typical …
How and when should coagulopathies be corrected? Coagulopathies should be corrected with appropriate transfusions of packed red blood cells or hemostatic agents such as platelets, fresh-frozen plasma, vitamin K, cryoprecipitate, protamine, and recombinant factor VIIa. Institutional guidelines vary, but an INR greater than 2, a PTT greater than 1.5 times normal, or a platelet count …
What coagulation parameters are assessed before a percutaneous procedure? The patient history should be reviewed for bleeding risks, such as anticoagulant (warfarin [Coumadin], low-molecular-weight heparin) or platelet-inhibitor (aspirin, clopidogrel [Plavix]) agents, uremia, or hepatocellular disease. Routinely assessed parameters include hematocrit, prothrombin time, international normalized ratio (INR), partial thromboplastin time (PTT), and platelet count.