Performed at one institution, Not applicable, Metastases, Cancer, Biopsy, Ablation procedures, Percutaneous, Fluoroscopy, CT, Thorax, Interventional non-vascular, Interventional Radiology
E. Krešić1, M. Prutki1, M. Cavka1, I. Kuhtić1, A. Marusic2, A. M. Alduk1; 1Zagreb/HR, 2Samobor/HR
Findings and procedure details
Thermal ablation is performed under deep sedation and local anesthesia, while percutaneous biopsy is performed in local anesthesia, only.
The needle entry site and path are planned after non-enhanced CT of the liver.
The entry site is cleansed with 2% chlorhexidine gluconate and sterilely draped.
After administration of local anesthesia, a small skin incision is made.
A spring-loaded insufflation needle (Veress needle) is inserted through the skin incision and advanced towards pleural space. As the needle enters the pleural cavity, a distinct click is heard as the blunt-tip portion of the Veress needle springs forward into the pleural cavity. A small amount of air (3-5 mL) is then injected and the correct position of the needle tip in pleural space is confirmed with CT (Fig. 2).
Air is then injected with a 50 mL syringe to separate the lung from the pleura. Usually, 150-300 mL of air is required to create a safe pathway to hepatic dome lesions which is confirmed with CT.
The Veress needle is left in place during the procedure - thermal ablation or biopsy (Fig. 3).
Following the procedure, the Veress needle is used in combination with stopcock to aspirate and expel the intrapleural air until complete resolution (Fig. 4.).
A follow-up chest radiograph should be done two hours after the procedure to assess potential recurrence of pneumothorax.