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