Ultrasound-Guided Percutaneous Drainage Procedures

Abstract

Ultrasound-guided procedures, especially those that are for needle guidance, are all based on the learned skill of being able to track the needle tip the entire time, while it is in the patient under ultrasound imaging. By learning this critical skill, the physician should feel confident in the successful completion of both simple and more complicated, invasive procedures. Ultrasound-guided percutaneous drainage or aspiration of abnormal fluid collections is becoming standard of care in current clinical practice. Ultrasound guidance has led to reduced morbidity and mortality and decrease in length of stay and healthcare costs. Ultrasound-guided percutaneous drainage is minimally invasive and relatively inexpensive and has several advantages over CT including real-time guidance and lack of radiation.

This chapter will introduce the physician to both commonplace, relatively simple incision and drainage procedures of subcutaneous abscesses and hematomas and more rare, invasive procedures such as drainage of intra-abdominal fluid collections and placement of percutaneous drains into those fluid collections. The overall principle of this range of procedures is the same: ability to utilize ultrasound to visualize and guide a needle into any space of the body for successful completion of the procedure. Each of these procedures will be explained: indications, contraindications, equipment, procedure preparation, step-by-step procedure explanation, and complications. Pearls and pitfalls will also be discussed to help prevent the possible complications. Suggestions to integrate these skills into clinical practice and the evidence to support the procedures will be covered.