Bending percutaneous drainage catheters to facilitate CT-guided insertion using curved trocar technique.

Abstract

To assess the safety and efficacy of placing thoraco-abdominal drainage catheters under CT-guidance using a curved trocar technique. A retrospective study of 182 CT/CT-fluoroscopy-guided thoraco-abdominal catheter drainages was conducted; half were performed by residents or fellows under the supervision of one radiologist (Group 1) and the other half under the supervision of 10 other radiologists (Group 2). Group 1 procedures employed a curved catheter assembly placed using trocar technique (n=44) or straight catheters placed with Seldinger technique (n=47). Group 2 procedures employed a straight catheter placed using trocar technique (n=16) or straight catheters placed with Seldinger technique (n=75). Technical success, procedure time, radiation dose (CT Dose Index CTDIvol), and adverse events (Common Terminology Criteria for Adverse Events, 4.0) were compared between techniques and groups using Student's t test, Fisher's exact test or Chi-square analysis. All procedures in groups 1 and 2 were technically successful. Mean procedure time for Group 1 curved trocar technique (28±8min) was shorter than groups 1 and 2 Seldinger technique (37±11min, p=.00002). Mean CTDIvol for Group 1 curved trocar technique (107.8±54.2mGy) was lower than groups 1 and 2 Seldinger technique (136.1±99.7mGy, p=0.032). Adverse event rates for curved trocar, straight trocar, and Seldinger techniques were 2.3% (1/44), 0% (0/16), and 3.3% (4/122), respectively (p=1); all were grade 1 or 2, and no catheter malfunctions occurred. The curved catheter trocar technique is a safe and effective modification of the standard trocar technique that may facilitate CT-guided procedures impeded by CT gantry size limitations.