Drainage catheters and biopsy needles

John Hancock

IR-TB April 2007

RCR IR curriculum

• ‘Biopsy and fluid drainage techniques are practised by all radiologists and are not included in this curriculum’

• Patient prep.

• Consent

• Anaesthesia/sedation

• Image guidance

• Techniques

• Aftercare

Drains

Drains

• Will aspiration do?

• Type

• Size

• Approach/position

• Guidance

• Fixation

Type

• Pigtail or pigtail?

• Locking or non-locking?

• Sump?

• Number?

Size?

• Thin fluid 6 – 8 Fr

• Thin pus 8 – 10 Fr

• Thick pus 10 – 12 Fr

• Up to 20Fr+

Technique

• Needle, then…

• One step, one stick, or

• Two step over guidewire

Biopsy

• Needle type

• Image guidance

• Techniques– Coaxial– Transjugular– Plugged

Gauge

• Based on the Stubs Iron Wire Gauge measurement

• Inversely proportional and non-linear (thanks)

Aspiration cytology

• Fine needle

• 21 or 22g Chiba

• Safe

• Limited application – cells not tissue

Cutting needles

• Many types• 14g to 18g• Length of throw (variable)• Core of tissue• Manual• Automated/‘programmable’• Side notch• End cut

Familiarise yourself

Familiarise yourself

• This is my biopsy gun

• There are many like it but this one is mine

• My gun is my best friend

• I must master it as I must master my life

• My gun without me is useless

• Without my gun I am useless

• I must aim my gun true

Specimens

• Size (renal and lymphoma)

• Don’t forget microbiology

• They’re your responsibility