What is percutaneous abscess drainage?
Fluid can collect within the body, either as a result of a disease such as pancreatitis, diverticulitis or appendicitis, or sometimes after surgery done to treat other conditions.
If the fluid is infected, then it is called an abscess. Because there is no blood supply inside the abscess cavity, and antibiotics will not be able to treat the infection, the infected fluid must be drained (removed from the body). If the fluid collection is large, it may take up space and prevent adjacent organs from functioning, or may cause pain by pressing on nerves.
Percutaneous abscess drainage is a way of sampling and draining the fluid without surgery, using image guidance. Besides relieving the pressure from the abscess, the drainage procedure can yield a sample of fluid which can be sent to a laboratory to confirm whether the best antibiotic for treating the particular infection.
How should I prepare?
Before the procedure, you should have blood tested to determine how well your blood clotting is functioning. You should inform your doctor of all medications you are taking, including any herbal supplements. Inform us of any allergies, particularly to local or general anesthetic medications or to contrast materials (sometimes called X-ray dye) or to latex gloves. Always inform your doctor if you are or may be pregnant.
Eat a light meal the evening before. You may be instructed not to eat or drink after midnight before the procedure, and if you are diabetic you should receive instructions from your doctor about adjusting medications and insulin dose on the day of the procedure. You will likely be asked to remove your clothing and wear a gown during the procedure. You will need a ride home with a friend or relative.
How is the procedure performed?
An interventional radiologist will use a form of imaging to find a safe pathway to reach the fluid collection. Most often this will be done with a CT scanner or ultrasound machine. The patient may have to lie on their back or side, or face down, to find the safest approach to the abscess avoiding other organs and blood vessels. The skin is cleaned and covered with a sterile drape and a local anesthetic is given at the skin puncture site as well as along the pathway to the abscess. A thin needle is advanced into the collection and is then exchanged for a thin plastic tube or catheter, to allow removal of the fluid. Unless the abscess is very small, the catheter will usually be left in place for a few days, attached to a collecting bag to allow all of the infected fluid to drain. The procedure usually takes less than one hour.
What will I experience during and after the procedure?
Local anesthetic causes a stinging or burning sensation. Placing the catheter into the abscess will likely give a feeling of pressure, but should not be painful. If sedation is used, you may feel relaxed and sleepy, but likely remain awake. In general, when an abscess is drained, patients will be admitted to the hospital for a few days.
How will I get my results?
The interventional radiologist will be able to inform you whether the procedure was technically successful.
What are the benefits and risks?
Infected fluid can be removed without the need for surgery.
Placing a needle into infected fluid may cause sudden development of fever and bloodstream infection. For this reason most patients will already have been given intravenous antibiotics before the procedure.
Internal bleeding or injury of adjacent organs can still occur even when guidance by CT scan or ultrasound are used.
The drainage catheter may become blocked or dislodged, requiring exchange or replacement. Very large or complicated abscesses may require more than one catheter, or extended periods of drainage for complete treatment.
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