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Drainage Procedures
Jennifer R. Buckley, MD, MBA; Brandt C. Wible, MD
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KEY FACTS

  • Terminology

    • Preprocedure

      • Procedure

        • Post Procedure

          • Outcomes

            TERMINOLOGY

            • Definitions

              • Aspiration: Placement of needle/catheter for fluid removal
                • Thoracentesis/paracentesis: Aspiration of pleural effusion/ascites
                • Diagnostic fluid sampling from small or technically challenging collections
              • Drainage: Placement of indwelling catheter for fluid/air removal
                • Trocar technique: Advancing drain directly into collection over sharp inner stiffener
                  • 1 stick, typically shorter duration than Seldinger
                  • Often used for shallow, larger collections
                • Seldinger technique: Tracking drain into collection over wire that has been previously advanced into collection through hollow access needle
                  • Advisable in small &/or deep collections
                • Approach: Shortest distance, avoid critical structures
                  • Transpleural (TP): Evacuation of pneumothorax (apical) or drainage of effusion/empyema (basilar)
                  • Transabdominal (TA): Through anterior/lateral abdomen, generally shortest route, most easily tolerated by patients
                  • Transgluteal (TG): Access deep pelvis when obscured anteriorly by bowel, often more painful than TA approach
                  • Transrectal (TR): Access prostatic abscess or collections anterior/posterior to rectum
                  • Transvaginal (TV): Access pelvic collections anterior to rectum
              • Tunneled pleural/peritoneal drainage: Palliative drainage of pleural effusion/ascites via long-term indwelling catheter that is tunneled subcutaneously
                • Often for malignancy but can be for benign end-stage disease (e.g., heart failure or cirrhosis)
              • Sclerotherapy: Injection of sclerosant via indwelling drain for treatment of high-output collection

            PREPROCEDURE

            • Indications

              • Contraindications

                • Preprocedure Imaging

                  • Getting Started

                    PROCEDURE

                    • Patient Position/Location

                      • Procedure Steps

                        • Findings and Reporting

                          • Alternative Procedures/Therapies

                            POST PROCEDURE

                            • Drain Catheter Removal Criteria

                              • Things to Do

                                • Things to Avoid

                                  OUTCOMES

                                  • Problems

                                    • Complications

                                      • Expected Outcomes

                                        Selected References

                                        1. De Filippo M et al: CT-guided percutaneous drainage of abdominopelvic collections: a pictorial essay. Radiol Med. 126(12):1561-70, 2021
                                        2. Episalla NC et al: Sclerotherapy as an alternative treatment for complex, refractory seromas. J Surg Case Rep. 2021(8):rjab224, 2021
                                        3. Kodzis E et al: Common options and overlooked alternative for drainage of inaccessible presacral abscess: a case report. Acta Med Litu. 28(1):170-5, 2021
                                        4. Lui MM et al: Complications of indwelling pleural catheter use and their management. BMJ Open Respir Res. 3(1):e000123, 2016
                                        5. Yong L et al: Abdominal drainage versus no abdominal drainage for laparoscopic cholecystectomy: a systematic review with meta-analysis and trial sequential analysis. Int J Surg. 36(Pt A):358-68, 2016
                                        6. Gee MS et al: Management of abdominal and pelvic abscesses that persist despite satisfactory percutaneous drainage catheter placement. AJR Am J Roentgenol. 194(3):815-20, 2010
                                        7. Merritt RE et al: Evidence-based suggestions for management of air leaks. Thorac Surg Clin. 20(3):435-48, 2010
                                        8. Josephson T et al: Amount drained at ultrasound-guided thoracentesis and risk of pneumothorax. Acta Radiol. 50(1):42-7, 2009
                                        9. Beland MD et al: Complex abdominal and pelvic abscesses: efficacy of adjunctive tissue-type plasminogen activator for drainage. Radiology. 247(2):567-73, 2008
                                        10. Gervais DA et al: Adjunctive intrapleural tissue plasminogen activator administered via chest tubes placed with imaging guidance: effectiveness and risk for hemorrhage. Radiology. 246(3):956-63, 2008
                                        11. Saokar A et al: Transvaginal drainage of pelvic fluid collections: results, expectations, and experience. AJR Am J Roentgenol. 191(5):1352-8, 2008
                                        12. Feller-Kopman D et al: Large-volume thoracentesis and the risk of reexpansion pulmonary edema. Ann Thorac Surg. 84(5):1656-61, 2007
                                        13. Gervais DA et al: Recurrent abdominal and pelvic abscesses: incidence, results of repeated percutaneous drainage, and underlying causes in 956 drainages. AJR Am J Roentgenol. 182(2):463-6, 2004
                                        14. Maher MM et al: The inaccessible or undrainable abscess: how to drain it. Radiographics. 24(3):717-35, 2004
                                        15. Harisinghani MG et al: Transgluteal approach for percutaneous drainage of deep pelvic abscesses: 154 cases. Radiology. 228(3):701-5, 2003
                                        16. Titton RL et al: Urine leaks and urinomas: diagnosis and imaging-guided intervention. Radiographics. 23(5):1133-47, 2003
                                        17. Gervais DA et al: Percutaneous abscess drainage in Crohn disease: technical success and short- and long-term outcomes during 14 years. Radiology. 222(3):645-51, 2002
                                        18. Harisinghani MG et al: CT-guided transgluteal drainage of deep pelvic abscesses: indications, technique, procedure-related complications, and clinical outcome. Radiographics. 22(6):1353-67, 2002
                                        19. O'Neill MJ et al: Transvaginal interventional procedures: aspiration, biopsy, and catheter drainage. Radiographics. 21(3):657-72, 2001
                                        20. Moulton JS: Image-guided management of complicated pleural fluid collections. Radiol Clin North Am. 38(2):345-74, 2000
                                        21. vanSonnenberg E et al: Percutaneous drainage of thoracic collections. J Thorac Imaging. 13(2):74-82, 1998
                                        22. Gazelle GS et al: Abdominal abscess. Imaging and intervention. Radiol Clin North Am. 32(5):913-32, 1994
                                        23. Morrison MC et al: Sclerotherapy of malignant pleural effusion through sonographically placed small-bore catheters. AJR Am J Roentgenol. 158(1):41-3, 1992
                                        24. Silverman SG et al: Thoracic empyema: management with image-guided catheter drainage. Radiology. 169(1):5-9, 1988
                                        25. vanSonnenberg E et al: CT- and ultrasound-guided catheter drainage of empyemas after chest-tube failure. Radiology. 151(2):349-53, 1984
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Preprocedure

                                            • Procedure

                                              • Post Procedure

                                                • Outcomes

                                                  TERMINOLOGY

                                                  • Definitions

                                                    • Aspiration: Placement of needle/catheter for fluid removal
                                                      • Thoracentesis/paracentesis: Aspiration of pleural effusion/ascites
                                                      • Diagnostic fluid sampling from small or technically challenging collections
                                                    • Drainage: Placement of indwelling catheter for fluid/air removal
                                                      • Trocar technique: Advancing drain directly into collection over sharp inner stiffener
                                                        • 1 stick, typically shorter duration than Seldinger
                                                        • Often used for shallow, larger collections
                                                      • Seldinger technique: Tracking drain into collection over wire that has been previously advanced into collection through hollow access needle
                                                        • Advisable in small &/or deep collections
                                                      • Approach: Shortest distance, avoid critical structures
                                                        • Transpleural (TP): Evacuation of pneumothorax (apical) or drainage of effusion/empyema (basilar)
                                                        • Transabdominal (TA): Through anterior/lateral abdomen, generally shortest route, most easily tolerated by patients
                                                        • Transgluteal (TG): Access deep pelvis when obscured anteriorly by bowel, often more painful than TA approach
                                                        • Transrectal (TR): Access prostatic abscess or collections anterior/posterior to rectum
                                                        • Transvaginal (TV): Access pelvic collections anterior to rectum
                                                    • Tunneled pleural/peritoneal drainage: Palliative drainage of pleural effusion/ascites via long-term indwelling catheter that is tunneled subcutaneously
                                                      • Often for malignancy but can be for benign end-stage disease (e.g., heart failure or cirrhosis)
                                                    • Sclerotherapy: Injection of sclerosant via indwelling drain for treatment of high-output collection

                                                  PREPROCEDURE

                                                  • Indications

                                                    • Contraindications

                                                      • Preprocedure Imaging

                                                        • Getting Started

                                                          PROCEDURE

                                                          • Patient Position/Location

                                                            • Procedure Steps

                                                              • Findings and Reporting

                                                                • Alternative Procedures/Therapies

                                                                  POST PROCEDURE

                                                                  • Drain Catheter Removal Criteria

                                                                    • Things to Do

                                                                      • Things to Avoid

                                                                        OUTCOMES

                                                                        • Problems

                                                                          • Complications

                                                                            • Expected Outcomes

                                                                              Selected References

                                                                              1. De Filippo M et al: CT-guided percutaneous drainage of abdominopelvic collections: a pictorial essay. Radiol Med. 126(12):1561-70, 2021
                                                                              2. Episalla NC et al: Sclerotherapy as an alternative treatment for complex, refractory seromas. J Surg Case Rep. 2021(8):rjab224, 2021
                                                                              3. Kodzis E et al: Common options and overlooked alternative for drainage of inaccessible presacral abscess: a case report. Acta Med Litu. 28(1):170-5, 2021
                                                                              4. Lui MM et al: Complications of indwelling pleural catheter use and their management. BMJ Open Respir Res. 3(1):e000123, 2016
                                                                              5. Yong L et al: Abdominal drainage versus no abdominal drainage for laparoscopic cholecystectomy: a systematic review with meta-analysis and trial sequential analysis. Int J Surg. 36(Pt A):358-68, 2016
                                                                              6. Gee MS et al: Management of abdominal and pelvic abscesses that persist despite satisfactory percutaneous drainage catheter placement. AJR Am J Roentgenol. 194(3):815-20, 2010
                                                                              7. Merritt RE et al: Evidence-based suggestions for management of air leaks. Thorac Surg Clin. 20(3):435-48, 2010
                                                                              8. Josephson T et al: Amount drained at ultrasound-guided thoracentesis and risk of pneumothorax. Acta Radiol. 50(1):42-7, 2009
                                                                              9. Beland MD et al: Complex abdominal and pelvic abscesses: efficacy of adjunctive tissue-type plasminogen activator for drainage. Radiology. 247(2):567-73, 2008
                                                                              10. Gervais DA et al: Adjunctive intrapleural tissue plasminogen activator administered via chest tubes placed with imaging guidance: effectiveness and risk for hemorrhage. Radiology. 246(3):956-63, 2008
                                                                              11. Saokar A et al: Transvaginal drainage of pelvic fluid collections: results, expectations, and experience. AJR Am J Roentgenol. 191(5):1352-8, 2008
                                                                              12. Feller-Kopman D et al: Large-volume thoracentesis and the risk of reexpansion pulmonary edema. Ann Thorac Surg. 84(5):1656-61, 2007
                                                                              13. Gervais DA et al: Recurrent abdominal and pelvic abscesses: incidence, results of repeated percutaneous drainage, and underlying causes in 956 drainages. AJR Am J Roentgenol. 182(2):463-6, 2004
                                                                              14. Maher MM et al: The inaccessible or undrainable abscess: how to drain it. Radiographics. 24(3):717-35, 2004
                                                                              15. Harisinghani MG et al: Transgluteal approach for percutaneous drainage of deep pelvic abscesses: 154 cases. Radiology. 228(3):701-5, 2003
                                                                              16. Titton RL et al: Urine leaks and urinomas: diagnosis and imaging-guided intervention. Radiographics. 23(5):1133-47, 2003
                                                                              17. Gervais DA et al: Percutaneous abscess drainage in Crohn disease: technical success and short- and long-term outcomes during 14 years. Radiology. 222(3):645-51, 2002
                                                                              18. Harisinghani MG et al: CT-guided transgluteal drainage of deep pelvic abscesses: indications, technique, procedure-related complications, and clinical outcome. Radiographics. 22(6):1353-67, 2002
                                                                              19. O'Neill MJ et al: Transvaginal interventional procedures: aspiration, biopsy, and catheter drainage. Radiographics. 21(3):657-72, 2001
                                                                              20. Moulton JS: Image-guided management of complicated pleural fluid collections. Radiol Clin North Am. 38(2):345-74, 2000
                                                                              21. vanSonnenberg E et al: Percutaneous drainage of thoracic collections. J Thorac Imaging. 13(2):74-82, 1998
                                                                              22. Gazelle GS et al: Abdominal abscess. Imaging and intervention. Radiol Clin North Am. 32(5):913-32, 1994
                                                                              23. Morrison MC et al: Sclerotherapy of malignant pleural effusion through sonographically placed small-bore catheters. AJR Am J Roentgenol. 158(1):41-3, 1992
                                                                              24. Silverman SG et al: Thoracic empyema: management with image-guided catheter drainage. Radiology. 169(1):5-9, 1988
                                                                              25. vanSonnenberg E et al: CT- and ultrasound-guided catheter drainage of empyemas after chest-tube failure. Radiology. 151(2):349-53, 1984