We focus on the common Clinical Intervention procedures that are frequently performed in the ICU of our institution, including:

The thoracic intervencions:

• Thoracentesis
• Insertion of tube in the chest
• Pulmonary abscesses

Paracentesis

Cholecistostomy

Nephrostomy

Percutaneous biopsy

Collections of Abdominal Drainage Fluids

Pseudoaneurysm occlusion.

 We provide background on each condition and pathological analysis indications and contraindications of each corresponding procedure. We detail and illustrate the equipment of necessary paragraph each scenario and review procedure technique, potential patient positioning and complications.

toracocentesis

 Thoracocentesis guided by ultrasound is usually performed with ease. A body accumulation of pleural fluid is mostly accessible through percutaneous methods in contraindications. In the septic patient, a diagnostic thoracentesis is usually performed to evaluate the presence of empyema.

Usually, the east of the patient  upright position, with its back to the inteventionalist, fluidis pleural generally anechoic, also the residues or partitions may be present.

Patients who can not sit in their upright position, areplaced in the supine or decubitus position. Fig. 2

After sterile preparation of the skin, the local anesthesia of administred should from the surface of the skin to the pleural surface.

The location of the intercostal artery is also verified at the moment.

The method is simple how to use UN 18 or 20 gauge needle advance until fluid is obtained. Particularly if the procedure is diagnostic and therapeutic. Fig. 3

Complications:

Pneumothorax ..... 2.5-7%

Pain

Vasovagal reaction

Pulmonary edema due to bleeding reexpansion

Insertion chest tube

Complicated spills son pleural effusions that do not respond to medical treatment drainage require and. Empyema, hemothorax, and malignant pleural effusions son of All complicated. Indication for drainage are given in  Fig. 1

DPPN:

There are 3 stages of the evolution of empyema:

1.  Free flow of exudative effusion
2. Fibro-purulent Stage: The fibrin is deposited in the visceral and parietal surface
3. The Stage of Organization: fibroblasts and capillaries grow in the exudates and form a pleural shell.

Stages 1 and 2 respond to the insertion of the thoracic tube. 

Pulmonary abscesses

It is very important to distinguish between pulmonary abscess and empyema, because empyema requires external drainage, we find that most pulmonary abscesses are resolved by medical treatment.

Indications for external drainage of lung abscess :

Persistent sepsis after 5 to 7 days of theraty antibiotics

Abscesses 4 cm or more in diameter that are under tension

Abscesses 4 cm or more in diameter that are enlarging

Failure to wean the UN Unit fan due to a large abscess

PARACENTESIS

Ultrasound-guided paracentesis is commonly performed ICU.

Indications:

In a septic patient as a diagnostic procedure to evaluate spontaneous bacterial peritonitis.

Traumatic hemoperitoneum in the context of the ICU

More commonly, this procedureis unplugged urgently as a therapeutic measue for the symptomatic relief of tense ascites.

 This may be performed from the linear transducer scan, usually 6 MHz or mayor.

The preferred site for high volume paracentesis is chosen in the dependent position, local tales of as lower right or left quadrants. The site of punctute does select generally lateral to the rectus muscle to avoid accidental puncture of the inferior epigastric artery.

Paracentesis of large volume provides a fast resolution of scrotal symptoms minimum complications well tolerated by most patients. Fig. 4

Complications: (Rare)

• Aneurysm of the inferior epigastric artery
• hemorrhage
• Intestinal perforation
• Hypotension
• Dysfuncton circulatory ostparacentesis is associated with an increase in mortality and can be predicted by:

Administration of intravenous albumin (6-8 g / L ascites removed).

 Colecistostomy

Acute cholecystitis in high-risk patients in the ICU is difficult to manage.

In critically ill patients, septic cholecystostomy may be diagnostic and therapeutic. These patients  no child candidates for surgery.

Percutaneous aspiration of contents gallbladeer can be performed accurate diagnosis of acute cholecystitis. Fig. 7

From the transhepatic approach, a 22-gauge needle is directed toward the gallbladder and biliary aspirate, if the Gram staining is positive. If the culture demonstrates bacterial growth, the diagnosis of acute cholecystitis is made.

Cholecysostomy can be performed under ultrasound guideline in the ICU to avoid an emerging cholecystectomy. Fig. 5 Fig. 6

Nephrostomy

The principal indication emerging for percutaneous nephrostomy is pyohydronephrosis, which may occur in the native kidney or transplant.

Ultrasonography is an excellent method for guiding the initial placement of the percutaneous nephrostomy needle. Fig. 9

For A native kidney:

To GET A UN chalice using posterior posterolateral approach

For A Kidney Transplant:

For previous chalking GET UN

Percutaneous biopsy

Percutaneous ultrasound guided biopsy is also UN technically possible procedure.

Any biopsy injury that can be displayed by ultrasound can make one. The precision that it depends on the location of lesion size and histology, in general, ranges from 66% to 99%.

Bleeding is the most important complication, mortality generally ranges from 0.008% to 0.031%. Fig. 8

Fluid drain abdominal collections

TC is the technique of choice performed performed to detect abscesses, detected once, the UN unit drained abscess can be by means of CT or ultrasound guide. Ultrasound has many benefits, including its low cost mm, its ability to carry out a portable way next to the patient's bed, and Its multiplanar imaging capabilities. 

Technique:

Seldinger technique is favore UN less than the abscess is very large and superficial.

The fluid is localized and the path of the planned needle.

The site for insertion of the needle is marked, and the skin is  prepared and covered in a sterile manner.

After anesthesia a 22 G needle and local accustick introduction system allows you to reach the collection.

For thin pus, 8 to 10 F catheters sufficient enough. Catheters up to 10 F can be used as pus for more viscous.

The catheter is then secured to the skin with the adhesive fixing devices.

Rounds for tubes daily are carried out to evaluate progress of drainage. Once the liquid becomes serous, the outlet of the tube s

When reduced less than 20 ml for 24 hours, the patient has defervesced and laboratory test It is normal, the tube can be removed.

pseudoaneurisma oclusión

 Formation of pseudoaneurysm of the femoral artery is a complication look for known after vascular procedures based on catheter. Ultrasound guided compression or surgical correction are commonly used for your repair.

Under the color Doppler ultrasonography of a 22-gauge needle was positioned percutaneously in the psedoaneurysm. Uncompressed pseudoaneurysm was injected 0.5- 1 ml thrombin solution to induce thrombosis. Fig. 10,11

Doppler ultrasound examination was repeated in one day to confirm occlusion. Fig 12.