4:10 PM Abstract No. 115 - Hematomas - to drain or not to drain, the interventionalist's dilemma

Abstract

Purpose Determine outcomes associated with the percutaneous drainage of hematomas. Materials and Methods A retrospective analysis was performed of the last 50 drainages performed at this institution that had the appearance of bland blood products at drainage. 26 males and 24 females were included in the study with an age range of 14-90 and an average catheter placement time of 35 days. Evaluation of length of catheter drainage, need for reintervention, and outcomes were assessed. Results Of the 50 drainages in which fluid had the appearance of bland blood products expressed at drainage in the period between 8/2010- 2/2012, 41 had catheters placed. 9 were drained without catheter placement. Of the 9 in which a catheter was not placed, 0 had a positive culture. Of the 41 in which catheters were placed, 31 had positive cultures at analysis. 10 had negative cultures. Of the nine in which catheter placement was not performed 3 had minimal fluid aspirated, in 2 the clinician specifically requested no drain be placed, 1 was a liver lesion in which it was elected not to place a drain, and 3 were tiny collections in which the clinical services were requesting aspiration for culture only. All 50 were successfully drained by SIR criteria for diagnosis, with 46 patients resolving the clinical episode that precipitated drainage. Of these patients there were no serious complications associated with catheter placement, although 3 ultimately developed fistulas to bowel, pancreas, and biliary system, and the one death prior to catheter removal was related to multiorgan failure in a liver transplant patient perioperatively. Conclusion Hematoma drainage attempt may be warranted in most cases, given the very high association of bland appearing hematoma with positive culture (62%), and the frequency in which drainage was possible despite the collections appearing to contain only blood products(86%). In cases in which minimal fluid is returned from a collection that appears large enough to drain it may be appropriate to avoid catheter placement, as these collections may have a lower likelihood of infection.