Technique for placement of non-end-hole nasojejunal feeding tubes.

The authors describe a simple method for placing a non-end-hole nasojejunal feeding tube with fluoroscopic guidance by using a multipurpose catheter and guide wire. The method was used successfully in 12 patients with no side effects or complications.

Percutaneous inferior vena caval approach for long-term central venous access.

PURPOSE: The authors report their experience with the translumbar inferior vena cava (IVC) approach for central venous access during a 6-year period at three teaching hospital sites. PATIENTS AND METHODS: Twenty-nine percutaneous IVC central venous access catheters were inserted in 22 patients during a 6-year period in the radiology departments of three teaching hospital sites. All patients had undergone unsuccessful attempts at conventional central venous access. Information was gathered by retrospective radiologic and hospital chart review. RESULTS: All attempted placements were successful. Catheters were in place for a total of 3,510 catheter days. The average length of catheter placement was 121 days (range, 14-536 days). Life-table analysis predicted catheter function rates of 55% and 29% at 6 and 12 months, respectively. Three procedure-related complications occurred. A lower pole branch of the right renal artery was inadvertently entered with a 22-gauge needle during attempted IVC puncture in one patient without clinical sequelae. A second patient developed a small groin hematoma at the femoral venous puncture site, which resolved spontaneously. A third patient developed a moderate retroperitoneal hematoma, which resolved without specific intervention. The sepsis rate was 2.8 infections per 1,000 catheter days with an average time to infection of 127 days (range, 10-536 days). CONCLUSION: In the authors' experience of 29 translumbar central venous catheter insertions, all attempts were successful. Percutaneous central venous access via the IVC is a safe and effective option for patients in whom more conventional access is not possible.

Insertion of subcutaneous central venous infusion ports by interventional radiologists.

OBJECTIVE: To evaluate the safety and efficacy of radiologic implantation of subcutaneous chest wall infusion ports by interventional radiologists, rather than surgeons, at a tertiary care hospital. PATIENTS AND METHODS: Review of radiology department and hospital records for 38 patients (ranging in age from 21 to 70 years), in whom a total of 41 infusion ports had been inserted between January 1992 and January 1994. RESULTS: All of the implantations were successful. The only acute complication was pneumothorax, which occurred in one patient; insertion of a chest tube was required. There were no cases of hematoma, air embolism or arterial puncture. The infusion ports remained in place for 12 to 492 days (for a mean of 167 catheter days per patient). Total follow-up was 6863 catheter days. The overall incidence of catheter-related infection was 1.3/1000 catheter days; removal of the port was necessary in eight cases. Occlusion of the catheter occurred in two cases, one after 21 days and the other after 308 days. Neither migration nor fracture of the catheter tip occurred. Overall, removal of the port was required because of catheter-related complications in nine cases (22%); in these cases the port was removed after a mean of 181 (range 21 to 420) days. CONCLUSIONS: Because the success and complication rates observed here were similar to those reported for insertions performed in the operating room, the authors conclude that central venous infusion ports can be safely and efficiently implanted by interventional radiologists.

Reduction of bowel motion artifact during digital subtraction angiography: a comparison of hyoscine butylbromide and glucagon.

The authors compared the effectiveness of hyoscine butylbromide (Buscopan) and glucagon in reducing bowel motion artifact during abdominal intra-arterial digital subtraction angiography. Sixty-six patients referred to the radiology department of a tertiary-care hospital for abdominal angiography between October 1989 and July 1992 consented to participate in the study. Diabetic patients receiving insulin and those with glaucoma were not considered for the study. The patients were assigned at random to receive either Buscopan (39 patients) or glucagon (27) intravenously before angiography. Images obtained at three stages during the procedure were reviewed independently by three experienced vascular radiologists who were blinded as to treatment group; images for nine patients in the Buscopan group and seven in the glucagon group were excluded because of breathing artifact or body movement. For each image the radiologists scored bowel motion in each section of a six-section grid. The bowel motion scores during early, middle and late arterial phases and the total scores for the two groups did not differ significantly (t-test). On the basis of these findings, the authors continue to use Buscopan because it is less expensive than glucagon.

Deep pelvic abscesses: transrectal drainage with radiologic guidance.

Transrectal catheter drainage was performed under radiologic guidance in eight patients with deep pelvic abscesses during a 7-month period. One patient underwent two procedures. In five patients, the abscess could not be palpated at rectal examination. Seven procedures were performed with fluoroscopic guidance. Transrectal ultrasound was performed in conjunction with fluoroscopy for two procedures. Medium to large (8-14-F) locking catheters were used in seven procedures, and small (5-F) nonlocking pigtail catheters were used in two. The catheter was left in place for 3 days or less in all but one patient, in whom the catheter was left in place for 20 days. Five abscesses were drained through the anterior or anterolateral rectal wall and four, including one repeat drainage, through the posterior rectal wall. No complications occurred as a direct result of transrectal drainage. Successful initial drainage was established with clinical improvement in all cases. Two patients eventually required surgery, one for continued bleeding into an infected hematoma and one for abscess recurrence after tube dislodgment. Transrectal drainage performed with radiologic guidance is a safe, feasible procedure; is well tolerated by patients; and is relatively easy to perform with the techniques described.