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Drainage Procedures
Brandt C. Wible, MD; Ashraf Thabet, MD
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KEY FACTS

  • Terminology

    • Preprocedure

      • Procedure

        • Post Procedure

          TERMINOLOGY

          • Definitions

            • Aspiration: Removal of fluid by needle or catheter
            • Drainage: Fluid removal with catheter left indwelling
            • Seldinger technique: Tracking drain into collection over wire that has been previously advanced into collection through hollow access needle
              • Advisable in small, deep collections with limited access
              • Inexperienced proceduralists may find controlling wire difficult while advancing drain, resulting in lost access or malpositioned drains
            • Trocar technique: Advancing drain directly into collection over sharp inner stiffener
              • One-stick, typically shorter duration than Seldinger
              • Often used for shallow, larger collections
              • Tandem-trocar: Advancing drain in-parallel alongside smaller guiding needle
            • Transabdominal (TA) approach: Generally shortest route, most easily tolerated by patients
            • Transgluteal (TG) approach: To access to deep pelvic structures obscured by anterior bowel
              • Must choose route close to sacrococcygeal margin to avoid neurovascular structures
              • Often painful approach
            • Transrectal (TR) approach: To access prostatic abscess or collections anterior/posterior to rectum
            • Transvaginal (TV) approach: To access pelvic collections anterior to rectum
              • TV/TR catheters have highest risk of falling out

          PREPROCEDURE

          • Indications

            • Contraindications

              • Preprocedure Imaging

                • Getting Started

                  PROCEDURE

                  • Patient Position/Location

                    • Procedure Steps

                      • Alternative Procedures/Therapies

                        POST PROCEDURE

                        • Drain Catheter Removal Criteria

                          • Things to Do

                            • Things to Avoid

                              OUTCOMES

                              • Problems

                                • Complications

                                  • Expected Outcomes

                                    Selected References

                                    1. 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):358-368, 2016
                                    2. 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
                                    3. Beland MD et al: Complex abdominal and pelvic abscesses: efficacy of adjunctive tissue-type plasminogen activator for drainage. Radiology. 247(2):567-73, 2008
                                    4. Saokar A et al: Transvaginal drainage of pelvic fluid collections: results, expectations, and experience. AJR Am J Roentgenol. 191(5):1352-8, 2008
                                    5. 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
                                    6. Maher MM et al: The inaccessible or undrainable abscess: how to drain it. Radiographics. 24(3):717-35, 2004
                                    7. Harisinghani MG et al: Transgluteal approach for percutaneous drainage of deep pelvic abscesses: 154 cases. Radiology. 228(3):701-5, 2003
                                    8. Titton RL et al: Urine leaks and urinomas: diagnosis and imaging-guided intervention. Radiographics. 23(5):1133-47, 2003
                                    9. 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
                                    10. 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
                                    11. O'Neill MJ et al: Transvaginal interventional procedures: aspiration, biopsy, and catheter drainage. Radiographics. 21(3):657-72, 2001
                                    12. Gazelle GS et al: Abdominal abscess. Imaging and intervention. Radiol Clin North Am. 32(5):913-32, 1994
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Preprocedure

                                        • Procedure

                                          • Post Procedure

                                            TERMINOLOGY

                                            • Definitions

                                              • Aspiration: Removal of fluid by needle or catheter
                                              • Drainage: Fluid removal with catheter left indwelling
                                              • Seldinger technique: Tracking drain into collection over wire that has been previously advanced into collection through hollow access needle
                                                • Advisable in small, deep collections with limited access
                                                • Inexperienced proceduralists may find controlling wire difficult while advancing drain, resulting in lost access or malpositioned drains
                                              • Trocar technique: Advancing drain directly into collection over sharp inner stiffener
                                                • One-stick, typically shorter duration than Seldinger
                                                • Often used for shallow, larger collections
                                                • Tandem-trocar: Advancing drain in-parallel alongside smaller guiding needle
                                              • Transabdominal (TA) approach: Generally shortest route, most easily tolerated by patients
                                              • Transgluteal (TG) approach: To access to deep pelvic structures obscured by anterior bowel
                                                • Must choose route close to sacrococcygeal margin to avoid neurovascular structures
                                                • Often painful approach
                                              • Transrectal (TR) approach: To access prostatic abscess or collections anterior/posterior to rectum
                                              • Transvaginal (TV) approach: To access pelvic collections anterior to rectum
                                                • TV/TR catheters have highest risk of falling out

                                            PREPROCEDURE

                                            • Indications

                                              • Contraindications

                                                • Preprocedure Imaging

                                                  • Getting Started

                                                    PROCEDURE

                                                    • Patient Position/Location

                                                      • Procedure Steps

                                                        • Alternative Procedures/Therapies

                                                          POST PROCEDURE

                                                          • Drain Catheter Removal Criteria

                                                            • Things to Do

                                                              • Things to Avoid

                                                                OUTCOMES

                                                                • Problems

                                                                  • Complications

                                                                    • Expected Outcomes

                                                                      Selected References

                                                                      1. 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):358-368, 2016
                                                                      2. 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
                                                                      3. Beland MD et al: Complex abdominal and pelvic abscesses: efficacy of adjunctive tissue-type plasminogen activator for drainage. Radiology. 247(2):567-73, 2008
                                                                      4. Saokar A et al: Transvaginal drainage of pelvic fluid collections: results, expectations, and experience. AJR Am J Roentgenol. 191(5):1352-8, 2008
                                                                      5. 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
                                                                      6. Maher MM et al: The inaccessible or undrainable abscess: how to drain it. Radiographics. 24(3):717-35, 2004
                                                                      7. Harisinghani MG et al: Transgluteal approach for percutaneous drainage of deep pelvic abscesses: 154 cases. Radiology. 228(3):701-5, 2003
                                                                      8. Titton RL et al: Urine leaks and urinomas: diagnosis and imaging-guided intervention. Radiographics. 23(5):1133-47, 2003
                                                                      9. 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
                                                                      10. 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
                                                                      11. O'Neill MJ et al: Transvaginal interventional procedures: aspiration, biopsy, and catheter drainage. Radiographics. 21(3):657-72, 2001
                                                                      12. Gazelle GS et al: Abdominal abscess. Imaging and intervention. Radiol Clin North Am. 32(5):913-32, 1994