Unintended Thermal Injuries from Radiofrequency Ablation: Protection with 5% Dextrose in Water

Abstract

Instillation of D5 into the peritoneal cavity before hepatic radiofrequency ablation decreases the risk and severity of diaphragm and lung injuries compared with no pretreatment or pretreatment with 0.9% saline in this animal model. Pretreatment with D5 may increase both the safety of and the number of patients eligible for treatment with thermal therapies.

Design and validation of a thermoreversible material for percutaneous tissue hydrodissection

“…Hydrodissection barriers of 5, 8, and 11 mm were evaluated (approximately 30 mL, 50 mL, and 70 mL of fluid, respectively) commensurate with previous laboratory and clinical studies. 6,7,17,18 The ablation applicator was placed vertically 4.5 cm into the liver tissue, 1 cm from the fluid barrier. For RF ablations, a 3 cm water-cooled electrode (Covidien, Mansfield, MA) delivered a maximum power of 200 W from the RF ablation generator using internal impedance control for 10 min.…”

“…6,7,16,17 Damage to these tissues can cause minor complications such as pain and breathing difficulties to major complications such as bowel perforation and death. 6,7,17 Hydrodissection is the most widely utilized adjunctive technique to lower the risk of such complications. 6 During hydrodissection, fluid is injected between the treatment zone and susceptible tissues to provide a physical, thermal, and potential electrical barrier to protect the susceptible tissues.…”

“…Solutions such as 5% dextrose in water (D5W) and normal saline have been effective at reducing complications from peripheral thermal damage. 6,7,[16][17][18] However, these liquids are highly mobile, can migrate into the peritoneal space and can be absorbed quickly, potentially degrading the barrier during the ablation procedure. As a result, a relatively large amount of liquid (1-3 L) or continuous infusion is often necessary to ensure adequate protection which can result in patient discomfort following the procedure.…”

“…As a result, a relatively large amount of liquid (1-3 L) or continuous infusion is often necessary to ensure adequate protection which can result in patient discomfort following the procedure. 6,[17][18][19][20][21][22][23] We evaluated the feasibility of an alternative to conventional liquids: an aqueous poloxamer 407 (P407) hydrodissection material. Poloxamers are polyethylene oxidepolypropylene oxide-polyethylene oxide (PEO-PPO-PEO) triblock copolymers that traditionally serve as nonionic surfactants.…”

Percutaneous Spinal Tumor Management

“…Although considered minimally invasive, there is a potential risk of thermal injury to the adjacent vulnerable structures, such as bowel, gall bladder, urinary tract and nerves. To prevent these complications, several methods have been reported, which include fluid, gas or balloon interpositions between the adjacent non-target structures and the ablation zone (Kam et et Al, 2004, Laeseke et Al, 2006, Gangi et Al, 2007, Diehn et et Al, 2003. Placing a thermocouple adjacent to the non-target vulnerable structures provides continuous monitoring of the surrounding temperature and thus precise regulation of the cooling or heating regimens.…”