Published in:
01-08-2017
Bending percutaneous drainage catheters to facilitate CT-guided insertion using curved trocar technique
Authors:
Adam S. Young, Paul B. Shyn, Oren W. Johnson, Nisha I. Sainani, Richard D. Nawfel, Stuart G. Silverman
Published in:
Abdominal Radiology
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Issue 8/2017
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Abstract
Purpose
To assess the safety and efficacy of placing thoraco-abdominal drainage catheters under CT-guidance using a curved trocar technique.
Methods
A retrospective study of 182 CT/CT-fluoroscopy-guided thoraco-abdominal catheter drainages was conducted; half were performed by residents or fellows under the supervision of one radiologist (Group 1) and the other half under the supervision of 10 other radiologists (Group 2). Group 1 procedures employed a curved catheter assembly placed using trocar technique (n = 44) or straight catheters placed with Seldinger technique (n = 47). Group 2 procedures employed a straight catheter placed using trocar technique (n = 16) or straight catheters placed with Seldinger technique (n = 75). Technical success, procedure time, radiation dose (CT Dose Index CTDIvol), and adverse events (Common Terminology Criteria for Adverse Events, 4.0) were compared between techniques and groups using Student’s t test, Fisher’s exact test or Chi-square analysis.
Results
All procedures in groups 1 and 2 were technically successful. Mean procedure time for Group 1 curved trocar technique (28 ± 8 min) was shorter than groups 1 and 2 Seldinger technique (37 ± 11 min, p = .00002). Mean CTDIvol for Group 1 curved trocar technique (107.8 ± 54.2 mGy) was lower than groups 1 and 2 Seldinger technique (136.1 ± 99.7 mGy, p = 0.032). Adverse event rates for curved trocar, straight trocar, and Seldinger techniques were 2.3% (1/44), 0% (0/16), and 3.3% (4/122), respectively (p = 1); all were grade 1 or 2, and no catheter malfunctions occurred.
Conclusions
The curved catheter trocar technique is a safe and effective modification of the standard trocar technique that may facilitate CT-guided procedures impeded by CT gantry size limitations.