Radiology - Image Guided Drainage

This leaflet tells you about a procedure known as an image guided drainage or percutaneous drainage.

It explains what the procedure involves and the risks that are associated with the procedure. This leaflet is not meant to replace a discussion with your doctor or specialist nurse and should be used as a guide/starting point for the discussion.

What is an image guided drainage?

An image guided drainage is a procedure in which a collection of fluid is drained directly by inserting a drainage catheter (a fine plastic tube) in the collection through the skin (percutaneous).

This procedure is usually performed through a small incision in the skin under local anaesthetic using either ultrasound, x-ray or Computed tomography (CT).

Why do you need an image guided drainage?

You will need this procedure as you will have had a scan performed either using ultrasound or CT which will have shown that you have a collection that is suitable for drainage. Your medical team looking after you will have decided this is the most appropriate treatment for you.

There are many different types of collection you may have which including:

Ascites: Excess fluid build-up in your abdomen
Abscesses: Abscesses are localised pockets of infection containing pus.
Hematomas: Hematomas are collections of blood, either post- trauma or post-surgical.
Seromas: Seromas are collections of clear, lymphatic fluid.
Post-operative fluid collections: After surgery, fluid can accumulate in body cavities or wounds, leading to complications like infection or impaired healing.
Pleural effusions: Pleural effusions are fluid collections in the pleural space (around the lungs).

If you have an infective collection, antibiotics can be used to help treat it, but they are not always effective against large collections which is why a drain may be necessary for you.

Additionally, when inserting a drain, samples can be taken which can then be tested to show which antibiotics will be most effective.

What happens prior to the procedure?

You may have this procedure as an inpatient or as a day case/ outpatient. If you are a day case patient, you will be asked to attend the ward early so you can be admitted, and all the paperwork can be completed.

All patients will be asked not to eat solid food for six hours before the procedure. However, you should continue to drink as much clear fluid as you like until two hours before the procedure, and you can then have sips of clear fluid up until the procedure.

You should take regular medications at the normal times, with a sip of water.

If you are taking anti-coagulation (blood thinners) or anti- platelets (clot preventors) such as warfarin, you will be given instructions which will tell you whether this medication needs to be stopped and for how long. If you have not been given these instructions or may have forgotten, please contact the Interventional Radiology department at the hospital of your appointment.

If you have previously had a reaction to the dye (contrast agent) or a local anaesthesia, please contact the Interventional Radiology department.

If you are an outpatient/day case patient, you should have someone to drive you home following the procedure. Someone should be at home with you for 24 hours following the procedure. If you do not, please let the Interventional Radiology department know.

What are the risks of an image guided drainage?

An image guided drainage is considered a safe procedure but there are risks, as with any medical procedure.

Risks include:

• Allergic reaction to local anaesthetic/contrast dye
• Bleeding
• Bruising around insertion site
• Damage to a nearby organ (very rare)
• Infection
• The inability for a drain to be placed which may lead to an alternative form of treatment
• The possibility that the drainage catheter may become twisted or blocked requiring it to be replaced

Although there are possible complications that can arise, percutaneous drainage is normally very safe and is designed to improve your medical condition without need for a more invasive procedure, such as surgery.

Is x-ray guidance dangerous?

All x-ray machines use potentially harmful x-rays. Modern equipment is designed to keep the dose you receive as low as possible. If your doctor has asked for this test, they will have decided that the benefits from the procedure outweigh the risks from the very small dose of radiation that you receive.

What happens on the day?

If you are a day case patient, you will attend the ward early in the morning of your drainage. The radiologist (special x-ray doctor) will consent you for the procedure. They will explain what will happen, give you more information about the risks and you will be able to ask any questions you may have.

You will then sign the consent for which is you agreeing that you fully understand the procedure and the risks associated.
If you are an inpatient, the medical team looking after you will consent you for the procedure.

You will also have a cannula (small plastic tube) placed into a vein in your hand/arm. This is a precautionary measure in case you experience any bleeding during the procedure as it will give the team access so that they can either give you fluids or a blood transfusion if one is necessary.

What happens during the procedure?

The imaging used and your position will depend on the location of the collection within your body. You may have monitoring devices attached to your arm and finger which monitor your blood pressure and oxygen levels.

The procedure is performed under sterile conditions and the interventional team members performing your procedure will wear sterile gloves and will also wear a sterile gown. Your skin will be cleaned with a cold antiseptic and you will be covered with sterile drapes.

The Radiologist will use an ultrasound probe, X-rays or the CT scanner to decide on the most suitable point for inserting the drain.

Local anaesthetic will be injected into the skin to numb the area. This injection stings first and then makes the skin numb and reduces the chances that you may feel pain during the procedure. However, you may feel some pressure as the doctor pushes on the needle.

A fine needle is inserted into the collection and a small sample can be taken. What happens next depends on what the sample looks like. Most of the time, a guide wire will be placed into the collection to allow the correct positioning of a drainage tube (catheter). This will be connected to a drainage bag. Occasionally, the collection may simply be drained through the needle or small plastic tube, which is then completely removed.

How long will the drain stay in?

That decision will be made by your doctor. Some drains may stay in a short while and you may have some more scans to ensure the collection has drained.

What happens after the procedure?

Post procedure you will be taken back to the ward where nursing staff will carry out routine observations which include blood pressure, oxygen saturation and checking for bleeding around the insertion site.

You will generally be required to stay in bed for 2-4 hours.

Medical staff will attend the ward to remove the drain after a set amount of time/volume has been agreed with the consultant radiologist.

Observations will be carried out for a further 1-2 hours after the drain has been removed, prior to discharge.

Discharge will usually occur 6-8 hours after the procedure.

If the drain is removed immediately post procedure, you will still need observations to be carried out for at least four hours after the drain’s removal.

How will I feel afterwards?

There may be some pain at the site of the tube (drain) insertion and occasionally pain can occur in the back or shoulders, but these should respond to simple pain killers, ask your doctor to advise you which painkillers would be most suitable for you. If you develop severe pain in your abdomen, shoulder or chest or develop a fever or shortness of breath, inform the nurse in charge or if you have been discharged contact your GP surgery as soon as possible during working hours or attend your local A&E department if out of hours.

What if I decide not to have the drainage?

If you attend for your appointment and after a discussion with the radiologist you decide against having the test, then we will write to your referring doctor. They will then discuss with you your options for further treatment with you, at your next appointment in clinic.

When will I get the results?

If a sample has been taken, it will be sent to the labs for testing. The results will not be available on the same day of your procedure. The results will be sent to your referring doctor, and they will either write to you or arrange an outpatient appointment. The sample may come back as inconclusive meaning you may not get a definitive diagnosis.

What if I cannot attend my appointment?

If you have any queries about your appointment or cannot attend, then please telephone the Interventional Radiology department on 01612065091 (Salford) or please call 0161 656 1178 if your appointment is at Royal Oldham Hospital.

Could you be pregnant?

If there is any chance you could be pregnant, please call 0161 206 5091 if your appointment is at Salford Royal Hospital. Please call 0161 656 1178 if your appointment is at Royal Oldham Hospital.

I need an ambulance. How do I arrange one?

If you need an ambulance there are contact details on your appointment letter.
Please contact us if you are arriving by ambulance so we can time your appointment with your ambulance arrival. If we are not aware that you are coming by ambulance you may miss your appointment, and it may have to be rebooked.

If you need an interpreter?

If you need an interpreter for your examination, please call the department so that we can try and arrange this.