CLINICAL HISTORY:
CT Dose:
SEDATION: Monitored by the IR registered nurse or surrogate, an independent trained observer providing Moderate Sedation with fentanyl.
CONSENT: Following discussion procedure its risks benefits (including bleeding and vessel damage) and alternatives, review of readily available relevant imaging prior to the procedure informed consent was obtained witnessed and documented upon the chart. Standard presurgical timeout confirming patient procedure and when relevant side and site was performed. Any discrepancies were resolved via consultation with appropriate readily available data sources. The patient was prepared and draped in standard sterile fashion.
Procedure:
Risks and procedure were explained to the patient and the patient and the patient’s daughter. The patient and the patient’s daughter understood and consented to the procedure. Timeout was performed per protocol.
A safe approach in the right hemiabdomen was identified using CT and the site was market, prepped and draped in the usual sterile fashion. Procedure was done under sterile technique and local anesthesia using 1 % lidocaine.
Conscious sedation was provided by certified nursing staff after normal head/neck and cardiopulmonary exam, using 1mg Versed and 25 ug of Fentanyl intravenously.
19 gauge atraumatic Yueh needle was used to gain access into the gallbladder. A 0.035″ wire was advanced through the catheter into the gallbladder. the wire position was confirmed by CT images. The skin tract was then sequentially dilated up to 10F. A New 10 French locking pigtail drainage catheter was placed in the gallbladder percutaneously under CT guidance.
Approximately 200 ml of bile was aspirated. Gentle irrigation was performed using sterile normal saline. The catheter was secured to the skin with a stat lock device and a sterile dressing was applied. The drainage catheter was connected to a drainage bag.
Patient tolerated the procedure well. There were no immediate complications.
Impression:
Successful placement of a 10F locking pigtail cholecystostomy catheter as described
Frequently Asked Questions
What is a CT-guided cholecystostomy tube placement?
A CT-guided cholecystostomy tube placement is a minimally invasive procedure used to drain the gallbladder when it is inflamed or blocked. The procedure uses CT imaging to guide the insertion of a drainage tube into the gallbladder through the skin. This is typically done when surgery is too risky due to patient conditions.
Why is conscious sedation used during a cholecystostomy?
Conscious sedation is used to help the patient relax and minimize discomfort during the cholecystostomy procedure. It involves administering medications like Versed and Fentanyl, which reduce pain and anxiety while allowing the patient to remain awake and able to respond to instructions.
What are the risks associated with cholecystostomy tube placement?
Risks of cholecystostomy tube placement include bleeding, infection, and damage to nearby blood vessels or organs. However, these risks are minimized through careful imaging guidance and sterile techniques. Patients are informed of these risks prior to giving consent for the procedure.
How is the cholecystostomy tube secured after placement?
After the cholecystostomy tube is placed, it is secured to the skin using a device called a StatLock. This prevents the tube from moving or being accidentally dislodged. A sterile dressing is also applied to keep the area clean and protected from infection.
What should patients expect during the recovery from a cholecystostomy?
Patients can expect some mild discomfort at the insertion site after a cholecystostomy. The area will be monitored for signs of infection or other complications. Patients will have a drainage bag attached to collect bile, and they will receive instructions on how to care for the tube and manage drainage at home.
Why is CT imaging used in a cholecystostomy procedure?
CT imaging is used to provide detailed, real-time images of the abdominal organs, which helps the physician accurately guide the needle and drainage tube into the gallbladder. This precision minimizes the risk of complications and improves the success rate of the procedure.
What is the purpose of irrigating the gallbladder during a cholecystostomy?
Irrigation of the gallbladder with sterile saline during a cholecystostomy helps to clear any debris or thick bile that could block the drainage catheter. This ensures proper drainage of bile, reducing the risk of infection and facilitating faster recovery.