MEDRADSC 3C03 Lecture Notes - Lecture 5: Hydrophile, Percutaneous, Hemostat
27 May 2018
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Interventional Equipment
What’s a Heostat?
• Forceps
•
Mini Access Kit (Micropuncture Set)
• Used for small vessels or where an especially precise puncture is needed
• Puncture needle small caliber 21G seldinger style, and the wire it accepts is a .018-inch wire with
a stiff shaft and a straight floppy tip
o 21G provides precise movement
• Includes two part dilator that ultimately will allow for the insertion of an .035-inch wire
o Trying to allow conversion of a small access using at .018 inch wire to a larger guidewire
(0.035 inch wire)
o French- not like gauge (as size goes up, diameter goes up)
o Larger needle over top of the guidewire to stretch the access point
•
Co-axial Access Set (Neff or Accustick set)
• the non vascular version of the mini access set
o drainages
• 21 or 22G needle (Chiba), long with an inner stylet, accepts .018 wire
o Chiba: long needle, upwards of 15cm
o Need a longer needle that is also more rigid– harder to control
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• Two piece dilator ultimately allows for use of .035 wire
• Used for percutaneous trans hepatic cholangiography or difficult nephrostomy with an
undilated collecting system
o Lumbar punctures etc
•
Trocar
• employed in drainage procedures
• For large pathologies, not located in a critical structure
• Larger gauge —> ie. 17-19G
• Can come simply as a needle, or as part of a drainage catheter
•
•
o Parts:
▪ Cutting stylet (inside of:)
• what does the actual puncture
▪ Cannula (inside of:)
▪ Catheter (sometimes)
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• Catheter already on top
▪ Stylet and cannula get pulled out and the catheter is in
• Ho it’s used:
1. Introduced percutaneously into area of interest (eg. Abscess)
2. Stylet then removed
3. Cannula held in place while catheter is positioned to desired location (may need guide
wire)
4. Contrast medium to confirm position
5. Syringe (for small abscess) or extension tubing and a urinary drainage bag are attached
to drain abscess
o Always try to keep it below the site (even if it is a vacuum container)
Cook catheter (torcon blue biliary manipulation catheter)
• Short single-end hole steel braided catheter:
o for urinary & biliary work (deep structures: we need something that graded, metallic
structures woven together)
o excellent torque control (efficient)
• Reality → Dr. will have a preferred catheter they like to use to navigate
• Steal braided inside the blue part so that when the doc turns it, the tip turns as well (torque
control)
• Steel-graded eause e do’t at it to kik hard gettig through the apsule of the kide
•
Biopsies- FNA
• Fine needle used for aspiration with a 10ml syringe attached
o Fine Needle Aspiration (taking a few cells at a time, different than core biopsy)
• Suction applied to withdraw a few cells for cytology
• Often will have lab tech present with a microscope, aspirated cells sprayed on slide and
immediately viewed by lab tech to ensure adequate specimen/ not damaged
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find more resources at oneclass.com
Document Summary
Trocar: employed in drainage procedures, for large pathologies, not located in a critical structure, can come simply as a needle, or as part of a drainage catheter. Larger gauge > ie. 17-19g: parts, cutting stylet (inside of:, what does the actual puncture, cannula (inside of:, catheter (sometimes, catheter already on top, stylet and cannula get pulled out and the catheter is in, ho(cid:449) it"s used: Biopsies: core sample: used to obtain large core(s) of tissue, cutting needle used, needle often used with an automated gun, http://www. youtube. com/watch?v=hyacp_k_xk4, 1st dx is usually core sample a(cid:374)d the(cid:374) if looki(cid:374)g for (cid:373)ets tha(cid:374) it"s usuall(cid:455) a(cid:374) aspiratio(cid:374) Biopsies: co-axial biopsy needle: the inner portion shoots out and the outer cannula come out, cuts a portion and goes into the inner stylet. Ureteric stent systems: double j configuration, guide wire straightens, nothi(cid:374)g e(cid:454)ter(cid:374)al to (cid:271)od(cid:455).
