por Lynn Shapiro
, Writer | September 29, 2009
thoracic procedures at the Radiological Society of North America for the past two years, presenting CT tube pericardiostomy as part of the course.
"I will be doing it again this year," she tells DOTmed. "I clearly need more venues to get this information out to our surgical colleagues. Radiologists are capable of and willing to do the procedure but without the cardiothoracic surgeons' support we will not get the patient referrals."
How CT-Guided Tube Pericardiostomy Works
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Patients are brought to the radiology department, to CT, and placed on the table just as if they were getting a routine CT examination. Images of
the chest are taken without any contrast injection.
When conducting the procedure herself, Dr. Palmer says that first she decides whether the fluid around the heart is accessible and if it is, she chooses the safest route for the needle and tube to traverse, to avoid injuring the lung, the heart and the major vessels in the chest.
"All of these structures are very well seen on CT," she says. "When I have decided on the path, we can begin. There is no patient preparation needed. I clean the patient's chest and use a generous amount of lidocaine for local anesthesia. No general anesthesia is used and conscious sedation is necessary only when the patient is very anxious. Only one patient has needed anything more than local anesthesia."
She continues, "I then use a small sheathed needle to get through the skin and though the tough, fibrous covering around the heart (pericardium). I check on the location of the needle/catheter intermittently with CT scanning, in order to make sure that I am going in the correct direction and confirming that I am not near any vital structures.
"When I 'hit' fluid, I know that I am in the space around the heart. After I have reached the fluid, I take out the center needle from the catheter, and feed a wire through the catheter and into the fluid. After dilating the tract, I place the final catheter into the fluid over the wire, remove the wire and sew the catheter to the skin with one suture. I then remove all of the fluid from around the heart manually with a syringe, and the procedure is done. The catheter is small, almost the same size as IV tubing," Dr. Palmer says.
Awake and Alert
Throughout the procedure, Dr. Palmer talks to patients, telling them what she is doing and making sure that they are feeling okay. Even though she is working right in front of them, most patients have no problem with being awake and alert for this procedure, she says.
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