Management of Visceral Interventional Radiology Catheters: A Troubleshooting Guide for Interventional Radiologists

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.

Inadvertent Fracture of a Plastic Biliary Stent During a Combined Percutaneous–Endoscopic Procedure: A Word of Caution Regarding Self-Locking Pigtail Biliary Catheters

“…However, the use of such catheters is associated with additional difficulties, related to the locking mechanism. These include difficulty unlocking the pigtail, migration of the string inside the catheter, and retention of the string after removal of the catheter [6]. In the reported case, the plastic biliary stent was sectioned by the string of the locking mechanism, which was caught on the proximal flap of the stent (Fig.…”

Image-guided Percutaneous Drainage in the Pediatric Population: A Primer for Radiologists

“…[1] This has been well described and validated in literature as the preferred first line of treatment in both the pediatric and adult patients. [12] In pediatric population, special considerations, such as adjusted medication doses for sedation, preferential use of ultrasound for image guidance, smaller catheter sizes, and route of access/drainage, should be kept in mind.…”

“…[1] Although the presence of gas helps confirm an abscess, lack of air within the fluid collection does not exclude the diagnosis. [2] On CT, an abscess will often appear as a low density region with an enhancing rim. [2] On ultrasound, variable echogenicity is seen, often with a more hyperechoic rim.…”

“…[2] On CT, an abscess will often appear as a low density region with an enhancing rim. [2] On ultrasound, variable echogenicity is seen, often with a more hyperechoic rim. Layering debris or dirty shadowing secondary to gas can also be identified [Figure 1].…”

“…[2] Inadequate percutaneous access also includes the presence of an inter-loop abscess or a large amount of bowel near the abscess [Figure 4]. …”