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Management of Visceral Interventional Radiology Catheters: A Troubleshooting Guide for Interventional Radiologists¹

¹ From the Department of Radiology, St Vincent’s University Hospital, Dublin, Ireland. Recipient of a Cum Laude award for an education exhibit at the 2000 RSNA scientific assembly. Received April 19, 2001; revision requested July 6 and received September 18; accepted September 20. Address correspondence to M.M.M., Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, White 270, 55 Fruit St, Boston, MA 02114.

Visceral interventional radiology catheters can be difficult to exchange or remove for a variety of reasons. These reasons include exit of the guide wire through the side holes of the catheter, blockage of the catheter, difficulty unlocking the pigtail, retention of the string after catheter removal, migration of the string ahead of the guide wire, catheter fracture, and snaring of an adjacent stent by the pigtail. Secure fixation of the catheter to the skin is important. A technique that allows secure fixation without direct puncture and suturing of the catheter to the skin is recommended. If a catheter falls out or is inadvertently removed, access can occasionally be regained and the catheter can be replaced without repuncture. The timing of catheter removal is based on the clinical condition of the patient and the daily output from the catheter. "Tractography" is a useful study before removal of any catheter that requires a mature tract for removal, particularly cholecystostomy catheters and transpleural catheters. In biliary catheter exchange, the most vital issue is the position of the side holes of the catheter. If an abscess cavity remains large after catheter drainage, the catheter can be repositioned or a second catheter can be placed.

© RSNA, 2002

Index Terms: Catheters and catheterization, **.1269²² • Catheters and catheterization, complications, **.458 • Interventional procedures, **.1269 Interventional procedures, complications, **.458

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