Overview of Percutaneous Abscess Drainage
A medical procedure that is being used more and more involves inserting a drain or tube into a patient’s body with the help of imaging technology. This is commonly done by interventional radiologists or doctors who have similar training. When an abscess, or a pocket of pus, develops in the body, it typically needs to be drained. This process can get complicated if a simple cut and drain won’t work. Before, a more involved surgery might have been the go-to solution. But this technique, known as percutaneous drainage, offers an option that’s less invasive than surgery but more direct than non-invasive methods.
Doctors may use different types of imaging technology, like an ultrasound or a CT scan, to guide them in placing the drainage tube. The choice of imaging depends on what the doctor is most comfortable with and where the abscess is in the body. The type of imaging used plays a crucial role in shaping the process and assessing the risks involved. Percutaneous drainage can be used to treat many conditions, some common and some rare. These can include abscesses related to diverticulitis, a burst appendix, a liver abscess, an abscess inside the belly, or pools of fluid within the muscles.
Leaving an abscess untreated can be life-threatening and lead to a serious condition called sepsis, where the infection spreads through the bloodstream. Over the past 20 years, percutaneous drainage with image guidance has proven to be a safe and effective alternative to surgery. This method has also helped to reduce the complication rates and the duration of hospital stays.
Anatomy and Physiology of Percutaneous Abscess Drainage
An abscess is a kind of infection that can happen anywhere in the body. It’s formed when bacteria or other germs get into an area of the body and the body’s immune system tries to fight it off. As this battle happens, a wall forms around the infection, trapping it and creating a ‘pocket’. This pocket gets filled with pus, which is a mixture of dead immune cells, infectious organisms, and debris.
This can occur anywhere that bacteria or other infectious germs can reach in the body. Often, abscesses develop in the skin or in soft tissue. Other usual places include the sigmoid colon – a part of the large intestine – like when someone has a condition called diverticulitis. An abscess can also form during complicated cases of appendicitis. If the appendix ruptures or bursts, an abscess could form in the lower right side of your belly.
Why do People Need Percutaneous Abscess Drainage
There are several reasons why a doctor might use what’s called an image-guided percutaneous catheter. This is a minimally-invasive technique where a small tube is inserted into the body, usually to drain a pocket of pus called an abscess. The procedure is guided by medical imaging equipment to make sure the catheter is placed correctly.
Here are some of the main reasons why a doctor might opt for this procedure:
1. To treat multiple abscesses or those with many pockets of infection.
2. If the abscess is suspected to have a connection with the intestines.
3. If an abscess is bigger than 3 cm in size.
4. When the doctor isn’t sure what’s causing a person’s symptoms and wants to rule out or confirm abscesses as the cause.
5. If previous treatments have not worked – for instance, if medicines have not cleared the infection.
6. If the patient hasn’t been able to follow the medicine plan.”
When a Person Should Avoid Percutaneous Abscess Drainage
There are some situations in which a doctor might advise against performing a certain procedure called an image-guided percutaneous catheter insertion. Here are some reasons why this might happen:
Firstly, if a patient has ‘uncorrectable coagulopathy’, a condition where the blood doesn’t clot properly, this procedure may be unsafe. Blood clotting is essential to stop bleeding during and after the procedure.
Secondly, if there isn’t a clear and safe pathway to insert the catheter into the body, a doctor may decide not to perform the procedure. This is referred to as ‘lack of safe percutaneous access’.
Thirdly, if a patient is unable to cooperate with the procedure, perhaps due to a medical or mental health issue, the procedure might not be advisable. Cooperation is important for the procedure to be successful and safe.
Furthermore, informed consent is necessary for any medical procedure. If a patient doesn’t fully understand the procedure, or if it’s impossible to obtain their proper consent, the procedure shouldn’t be carried out.
Lastly, if the lesion (abnormal tissue) is too small, usually less than 3 cm, there may not be enough room to maneuver the wires, dilators, and the catheter loop. In this case, a doctor might decide not to perform this procedure.
Equipment used for Percutaneous Abscess Drainage
Here are some crucial tools that are needed for successfully performing a surgical drainage procedure:
- The choice of catheter, which is a thin tube, often depends on what size and shape will best get the job done.
- Catheters that are small in diameter (8-10 F) can effectively drain simple, clear body fluids.
- Catheters that have a larger diameter (more than 12 F) are optimally used for draining fluid from complex body cavities, like bloody fluid.
- A drainage bag to collect fluids.
- A sterile field, which is a clean environment that includes antiseptic substance called betadine and a fenestrated drape which is a protective sheet that has a hole or opening in it.
- A scalpel, which is a small sharp knife used in surgeries.
- An ultrasound or a CT scan might be used based on the specific procedure, doctor’s decision, and their expertise. These devices help create images of the inside of your body.
- A cardiac monitor that keeps track of your blood pressure, pulse rate, and the amount of oxygen in your blood.
Who is needed to perform Percutaneous Abscess Drainage?
Different types of medical professionals can do this procedure. Usually, it’s done by a specialist doctor called an interventional radiologist. They’re experts in procedures where they use images to guide them. This process is known as surgical drainage.
Other doctors like surgeons or emergency medicine physicians might also be trained to perform this procedure. These doctors often use a tool called an ultrasound to help them see inside your body during the procedure.
In some cases, healthcare workers like physician assistants or nurse practitioners might do the procedure. These are people who have had special training and been certified to perform them.
A nurse or technologist could also take part in the procedure to lend a hand. This extra assistance helps ensure that everything goes smoothly.
Preparing for Percutaneous Abscess Drainage
Before a medical procedure, doctors need to prepare patients in several ways. Here’s what the preparation stage generally looks like:
Firstly, understanding the procedure is important. The doctor should explain what is going to happen and get your agreement. This is called getting informed consent. In cases where the patient cannot make medical decisions, this consent might need to come from a person who can make decisions on behalf of the patient, known as a healthcare proxy.
Secondly, the doctor will run a series of tests. These might include imaging tests like scans, or lab tests that check your blood. Certain measurements in your blood need to be at specific levels to safely go ahead with the procedure.
For example, your platelet count, which relates to blood clotting, should ideally be at least 50,000 per microliter of blood. Your international normalized ratio (INR), which also involves clotting, should ideally be less than 1.5. Hemoglobin is another blood component your doctor will check – it delivers oxygen throughout your body and should be at least 9.0 g/dL, especially for patients with a higher risk.
Lastly, depending on the procedure and your specific case, the doctor may give you antibiotics through an IV (a tube inserted into your vein) to prevent infections. If they don’t know which specific germ might be a problem – a situation known as ‘unavailable sensitivities’ – then a broad-spectrum antibiotic might be used. These drugs are good at killing lots of different types of disease-causing bacteria that could be found in the particular part of your body being treated.
How is Percutaneous Abscess Drainage performed
Your doctor may use one of two unique approaches to remove or drain an abscess or body fluid collections: the Seldinger technique or the Trocar technique. The best method depends on the size of the abscess and where it is located in your body. The Seldinger technique is used for small abscesses that are deep within your body or hard to reach, while the Trocar technique is used for larger collections of fluid that are closer to the surface of the skin.
During the procedure, you’ll lie down on a table, and your doctor will connect you to a monitor to watch your vitals. A line for intravenous (IV) medicine (a drip) is inserted, so the doctor can give you sedation (medicine to make you sleepy) or fluids if needed. The doctor will clean the area where they’ll do the procedure to make sure it’s germ-free.
Depending on where your abscess is located in your body, local anesthesia (numbing medicine) might be used to lessen any discomfort. For longer or more painful procedures, your doctor may choose to use sedation to make you relaxed and drowsy.
A small cut is made in your skin to introduce a catheter (a thin, hollow tube) into your body. With the Seldinger technique, a small needle is used initially to get into the cavity where the abscess is. A thin wire is then used to guide a larger catheter into the area.
Alternatively, with the Trocar technique, a small needle is used to access the fluid collection and suck its contents out. This not only creates space for the procedure but also helps the doctor ensure the catheter is in the right place. Once the catheter is in the right place, using either method, it is connected to a bag outside of your body. This bag collects the fluid drained from the abscess or fluid collection.
Sometimes, doctors will use a system that creates a mild vacuum in the bag to help suck the fluid out. The catheter stays in place until all the fluid or pus in the abscess is drained, which may take several days.
Possible Complications of Percutaneous Abscess Drainage
When a doctor performs a procedure to drain an abscess (a pocket of pus) through the skin, which is called percutaneous abscess drainage, there can sometimes be complications specific to the area where the procedure was performed. These potential issues include:
- Pain: This is discomfort or soreness at the site where the procedure was done.
- Infection: This is when harmful bacteria get into the body, causing symptoms such as redness, swelling, and fever.
- Bleeding: This is when blood leaks out of the vessels. It can happen internally or can be visible on the outside of the body.
What Else Should I Know About Percutaneous Abscess Drainage?
Abscesses, otherwise known as pockets of pus that can form inside your body, are very serious and can cause significant illness and even death. They can potentially lead to a life-threatening condition called sepsis. Particularly, the deeper abscesses can make a patient extremely sick.
One of the ways doctors can treat these serious abscesses is through a method called image-guided percutaneous drainage. Essentially, this technique involves using advanced imaging technology to guide a small needle into the abscess to drain out the pus. This method is minimally invasive and can help very sick patients significantly. It also avoids the need for a major surgery under general anesthesia, which can often shorten the length of hospital stays and lessen healthcare costs.
This way of tackling abscesses can also aid in the more effective use of antibiotics. Generally, most abscesses are best treated by physically cutting them open and draining out the pus, not necessarily by using antibiotics. Nonetheless, if the abscess area on the skin begins to look red and the patient shows signs of being systemically unwell, like having a fever, feeling cold and overly tired, then antibiotics are generally considered. Personal health history should be taken into account when deciding the right antibiotics to use. This includes factors like diabetes, a past diagnosis of MRSA which is a type of bacteria that is resistant to several common antibiotics, a history of drug use via injection, among other considerations.
