75989 Radiological guidance (ie, fluoroscopy, ultrasound, or computed tomography), for percutaneous drainage (eg, abscess, specimen collection), with placement of catheter, radiological supervision and interpretation

Name of the Procedure:

Radiological Guidance for Percutaneous Drainage with Catheter Placement (Fluoroscopy, Ultrasound, or Computed Tomography)

Summary

This procedure involves using imaging technologies like fluoroscopy, ultrasound, or computed tomography (CT) to guide a needle and catheter into an area needing drainage. The focus is typically on draining abscesses or collecting fluid samples. A catheter is placed to ensure continuous drainage and proper monitoring of the site.

Purpose

Radiological guidance for percutaneous drainage is primarily performed to:

• Drain abscesses or fluid collections.
• Obtain specimens for diagnostic analysis.
• Reduce infection and alleviate pain caused by the built-up fluid or pus. The expected outcome is to effectively remove the undesired fluid, promote healing, and provide relief from symptoms.

Indications

• Presence of an abscess or localized infection.
• Fluid collection such as seromas, hematomas, or cysts.
• Symptoms like localized pain, swelling, and fever that suggest fluid buildup.
• Patients who are at high risk of complications from surgical drainage.

Preparation

• Patients are typically asked to fast for several hours before the procedure.
• Adjustments to medications, especially blood thinners, may be required.
• Pre-procedure diagnostic imaging and blood tests may be necessary to assess the infection and overall health condition.

Procedure Description

1. The patient is positioned appropriately based on the site of drainage.
2. Local anesthesia is administered to numb the area; sedation may also be used.
3. An imaging device (fluoroscopy, ultrasound, or CT) is employed to locate the fluid collection.
4. A needle guided by the imaging device is inserted into the target area.
5. Once correctly positioned, the needle is used to place a catheter into the site.
6. The catheter allows for continuous drainage of the fluid and may be left in place for several days.
7. Radiological supervision ensures correct catheter placement and effective drainage.

Duration

The procedure usually takes about 30 to 60 minutes, depending on the complexity of the case.

Setting

This procedure is typically performed in a hospital’s radiology department, an outpatient clinic, or a surgical center equipped with the necessary imaging technology.

Personnel

• Interventional radiologist or a specialized radiologist.
• Radiology technicians.
• Nursing staff.
• Anesthesiologist or nurse anesthetist (if sedation is used).

Risks and Complications

Common risks include:

• Minor bleeding at the insertion site.
• Infection.
• Pain or discomfort from the catheter. Rare but serious risks include:
• Damage to surrounding organs or tissues.
• Catheter malfunction or displacement. Management of complications usually involves antibiotics for infection or minor surgical interventions for catheter issues.

Benefits

• Rapid relief from symptoms caused by fluid accumulation.
• Accurate diagnosis through fluid analysis.
• Minimally invasive compared to open surgical drainage. Benefits are typically realized immediately or within a few days post-procedure.

Recovery

• Post-procedure, patients are advised to rest and monitor the catheter site for signs of infection.
• Pain management includes prescribed pain relievers.
• Follow-up appointments ensure proper healing and catheter removal when appropriate.
• Recovery time can vary; most patients return to normal activities within a few days.

Alternatives

• Surgical incision and drainage.
• Antibiotic therapy alone (if fluid collection is minimal).
• Expectant management (watchful waiting). Surgical options are more invasive with a longer recovery time but may be more effective for large or complex abscesses. Antibiotic therapy is less invasive but may not be sufficient alone for large fluid collections.

Patient Experience

During the procedure, the patient may feel slight pressure or mild discomfort at the insertion site. Post-procedure, mild pain or soreness might be experienced, which is generally manageable with pain medications. Patient comfort is a priority, and appropriate measures are taken to ensure a tolerable experience throughout the process.