228
TECHNICAL NOTES
Guide Wire for Percutaneous Transhepatic Cholangiography 1 Anders Lunderquist, M.D., Mats Lunderquist, M.S., and Torben Owman, M.D. The authors describe a new guide wire which facilitates percutaneous passage of a catheter into the bile ducts via the liver and is also helpful in percutaneous pyelostomy. INDEX TERMS: Catheters and catheterization. Cholangiography, instrumentation • Cholangiography, technique, 7 [6] .1226 • Nephropyelostomy (Kidney, cutaneous nephrostomy, 8 [ 1] .454)
the catheter of the puncture needle is in place in the bile duct, the guide wire is introduced and the flexible portion placed in the lower common bile duct or duodenum with the hard part extending approximately to the hilus of the liver. When exchanging the catheter for wider one which has multiple side holes for drainage, kinking is prevented by the hard part of the guide wire. In this way introduction of the drainage catheter is faster and less painful. We have found this new guide wire to be useful not only for PTC but also for introduction of a wide, soft catheter for percutaneous pyelostomy.
a
REFERENCES
Radiology 132:228, July 1979
Percutaneous transhepatic cholangiography (PTC) with the Chiba needle is an established method of demonstrating the bile ducts in obstructive jaundice. Once the cause of the obstruction is found, a catheter is commonly introduced to drain the bile ducts and improve the condition of the patient prior to surgery (1, 2). When the obstructing lesion is a nonresectable tumor, some authors have advocated introduction of an endoprosthesis (3, 4). However, when a drainage catheter or prosthesis is introduced over the guide wire, resistance by the liver parenchyma and the wall of the bile duct often causes the wire to become kinked either at the abdominal wall or between it and the liver. To overcome this problem, we have designed a new guide wire made up of two parts: a hard portion 80 cm long and composed of the same material as the needle stylet, and a flexible portion 5-10 cm long which is an ordinary guide wire. 2 When
Percutaneous Nephropyelostomy Using a Fine-Needle Puncture Set 1 Rolf Gi.inther, M.D., Peter Aiken, M.D., and Jens E. Altwein, M.D. The authors describe an improved method of percutaneous nephropyelostomy using a long, fine, flexible needle combined with a wider and shorter cannula. The needle facilitates atraumatic puncture of the renal collecting system and antegrade pyelography and subsequently serves as a guide over which the nephrostomy cannula is inserted. This technique was successful in 105 of 115 procedures (93 patients) over a period of 15 months and has replaced operative nephrostomy in the authors' hospital. INDEX
storny
(Kidney, cutaneous stroma, 8[1].454). NephropyeloPyelography, technique
TERMS: e
July 1979
Radiology 132:228-230, July 1979
Percutaneous nephrostomy is the natural outgrowth of antegrade pyelography, first reported in 1954 (28, 30). Recently we described a new technique for percutaneous nephropyelostomy (13) to supplement those already in the literature (1-8, 10, 14-16, 19-27). Since then, we have modified the puncture set and employed it in 115 procedures. TECHNIQUE As originally devised, the puncture set consisted of a fine needle (0.0. 0.7 mm, length 17 ern), a Seldinger cannula (1.0. 1.0 mm, 0.0.1.2 mm, length 10 ern), and a stylet. We now use a set which consists of a fine needle (0.0.0.7 mm, length 20 ern) and a nephrostomy needle (outer blunt cannula, inner bevelled
1. Burcharth F, Christiansen L, Efsen F, et al: Percutaneous transhepatic cholangiography in diagnostic evaluation of 160 jaundiced patients. Results of an improved technic. Am J 8urg 133:559-561, May 1977 2. Hoevels J, Lunderquist A, Ihse I: Percutaneous transhepatic intubation of bile ducts for combined internal-external drainage in preoperative and palliative treatment of obstructive jaundice. Gastrointest RadioI3:23-31, 15 Apr 1978 3. Burcharth F: A new endoprosthesis for nonoperative intubation of the biliary tract in malignant obstructive jaundice. Surg Gynecol Obstet 146:76-78, Jan 1978 4. Pereiras RV, Hutson D, Troner MB, et al: Percutaneous transhepatic insertion of a permanent prosthesis in the biliary tree-a non-surgical procedure for the relief of obstructive jaundice. Presented at the RSNA, Chicago, 111., Nov. 27-Dec. 2, 1977
1 From the Department of Diagnostic Radiology, University Hospital, 8-221 85 Lund, Sweden. Received May 31, 1978 and accepted August
1. 2
Surgimed, Olstykke, Denmark.
sjh
needle, and stylet) (Fig. 1). The outer cannula is 12 cm long, with an 1.0. of 1.0 mm and an 0.0. of 1.3 mm. This needle can be threaded into the renal collecting system more easily, even through fibrotic perirenal tissue. Puncture of the collecting system is done under fluoroscopy with image magnification. Prior opacification of the upper urinary tract by intravenous administration of contrast medium is desirable but not required. With the patient prone, the puncture site is chosen according to the method of Goodwin et al. (10). Under local anesthesia the short three-part nephrostomy needle is pushed through the musculature and fascia to the perirenal space. The inner stylet may be removed for local infiltration with anesthetic while advancing the cannula. Once the perirenal space is reached, the stylet is replaced by the long fine needle. The kidney is punctured and continuous infiltration of lidocaine is begun. A loss of resistance usually indicates that the collecting system has been entered. Injection of dilute methylglucamine diatrizoate (Angiografin) verifies the proper position. Using the fine needle as a guide, the nephrostomy cannula (blunt cannula + bevelled inner needle) is advanced. Shortly before entering the pelvocalyceal system, the sharp inner bevelled needle is withdrawn slightly in order to avoid unnecessary lesions. With the aid of a J guide wire (0.0. 0.9 mm) inserted into the upper urinary tract, the puncture channel is dilated with a short F6 Teflon catheter. The preferred nephrostomy tube for short-term drainage is a radiolucent thin-walled polyethylene catheter- (1.0. 1.7 mm, 0.0. 2.3 mm, length 35 cm) with 2 to 3 side holes close to the tip. For long-term external drainage this catheter is re-
TECHNICAL NOTES
Guide Wire for Percutaneous Transhepatic Cholangiography 1 Anders Lunderquist, M.D., Mats Lunderquist, M.S., and Torben Owman, M.D. The authors describe a new guide wire which facilitates percutaneous passage of a catheter into the bile ducts via the liver and is also helpful in percutaneous pyelostomy. INDEX TERMS: Catheters and catheterization. Cholangiography, instrumentation • Cholangiography, technique, 7 [6] .1226 • Nephropyelostomy (Kidney, cutaneous nephrostomy, 8 [ 1] .454)
the catheter of the puncture needle is in place in the bile duct, the guide wire is introduced and the flexible portion placed in the lower common bile duct or duodenum with the hard part extending approximately to the hilus of the liver. When exchanging the catheter for wider one which has multiple side holes for drainage, kinking is prevented by the hard part of the guide wire. In this way introduction of the drainage catheter is faster and less painful. We have found this new guide wire to be useful not only for PTC but also for introduction of a wide, soft catheter for percutaneous pyelostomy.
a
REFERENCES
Radiology 132:228, July 1979
Percutaneous transhepatic cholangiography (PTC) with the Chiba needle is an established method of demonstrating the bile ducts in obstructive jaundice. Once the cause of the obstruction is found, a catheter is commonly introduced to drain the bile ducts and improve the condition of the patient prior to surgery (1, 2). When the obstructing lesion is a nonresectable tumor, some authors have advocated introduction of an endoprosthesis (3, 4). However, when a drainage catheter or prosthesis is introduced over the guide wire, resistance by the liver parenchyma and the wall of the bile duct often causes the wire to become kinked either at the abdominal wall or between it and the liver. To overcome this problem, we have designed a new guide wire made up of two parts: a hard portion 80 cm long and composed of the same material as the needle stylet, and a flexible portion 5-10 cm long which is an ordinary guide wire. 2 When
Percutaneous Nephropyelostomy Using a Fine-Needle Puncture Set 1 Rolf Gi.inther, M.D., Peter Aiken, M.D., and Jens E. Altwein, M.D. The authors describe an improved method of percutaneous nephropyelostomy using a long, fine, flexible needle combined with a wider and shorter cannula. The needle facilitates atraumatic puncture of the renal collecting system and antegrade pyelography and subsequently serves as a guide over which the nephrostomy cannula is inserted. This technique was successful in 105 of 115 procedures (93 patients) over a period of 15 months and has replaced operative nephrostomy in the authors' hospital. INDEX
storny
(Kidney, cutaneous stroma, 8[1].454). NephropyeloPyelography, technique
TERMS: e
July 1979
Radiology 132:228-230, July 1979
Percutaneous nephrostomy is the natural outgrowth of antegrade pyelography, first reported in 1954 (28, 30). Recently we described a new technique for percutaneous nephropyelostomy (13) to supplement those already in the literature (1-8, 10, 14-16, 19-27). Since then, we have modified the puncture set and employed it in 115 procedures. TECHNIQUE As originally devised, the puncture set consisted of a fine needle (0.0. 0.7 mm, length 17 ern), a Seldinger cannula (1.0. 1.0 mm, 0.0.1.2 mm, length 10 ern), and a stylet. We now use a set which consists of a fine needle (0.0.0.7 mm, length 20 ern) and a nephrostomy needle (outer blunt cannula, inner bevelled
1. Burcharth F, Christiansen L, Efsen F, et al: Percutaneous transhepatic cholangiography in diagnostic evaluation of 160 jaundiced patients. Results of an improved technic. Am J 8urg 133:559-561, May 1977 2. Hoevels J, Lunderquist A, Ihse I: Percutaneous transhepatic intubation of bile ducts for combined internal-external drainage in preoperative and palliative treatment of obstructive jaundice. Gastrointest RadioI3:23-31, 15 Apr 1978 3. Burcharth F: A new endoprosthesis for nonoperative intubation of the biliary tract in malignant obstructive jaundice. Surg Gynecol Obstet 146:76-78, Jan 1978 4. Pereiras RV, Hutson D, Troner MB, et al: Percutaneous transhepatic insertion of a permanent prosthesis in the biliary tree-a non-surgical procedure for the relief of obstructive jaundice. Presented at the RSNA, Chicago, 111., Nov. 27-Dec. 2, 1977
1 From the Department of Diagnostic Radiology, University Hospital, 8-221 85 Lund, Sweden. Received May 31, 1978 and accepted August
1. 2
Surgimed, Olstykke, Denmark.
sjh
needle, and stylet) (Fig. 1). The outer cannula is 12 cm long, with an 1.0. of 1.0 mm and an 0.0. of 1.3 mm. This needle can be threaded into the renal collecting system more easily, even through fibrotic perirenal tissue. Puncture of the collecting system is done under fluoroscopy with image magnification. Prior opacification of the upper urinary tract by intravenous administration of contrast medium is desirable but not required. With the patient prone, the puncture site is chosen according to the method of Goodwin et al. (10). Under local anesthesia the short three-part nephrostomy needle is pushed through the musculature and fascia to the perirenal space. The inner stylet may be removed for local infiltration with anesthetic while advancing the cannula. Once the perirenal space is reached, the stylet is replaced by the long fine needle. The kidney is punctured and continuous infiltration of lidocaine is begun. A loss of resistance usually indicates that the collecting system has been entered. Injection of dilute methylglucamine diatrizoate (Angiografin) verifies the proper position. Using the fine needle as a guide, the nephrostomy cannula (blunt cannula + bevelled inner needle) is advanced. Shortly before entering the pelvocalyceal system, the sharp inner bevelled needle is withdrawn slightly in order to avoid unnecessary lesions. With the aid of a J guide wire (0.0. 0.9 mm) inserted into the upper urinary tract, the puncture channel is dilated with a short F6 Teflon catheter. The preferred nephrostomy tube for short-term drainage is a radiolucent thin-walled polyethylene catheter- (1.0. 1.7 mm, 0.0. 2.3 mm, length 35 cm) with 2 to 3 side holes close to the tip. For long-term external drainage this catheter is re-
