Sepsis in the Interventional Radiology Patient

Image-Guided Nephrostomy Interventions: How to Recognize, Avoid, or Get Out of Trouble

Image-guided percutaneous nephrostomy is a relatively safe and successful procedure for access to the renal collecting system for multiple purposes including relief of urinary obstruction, urinary diversion, access for endourologic procedures, and diagnostic testing. Although placing a percutaneous nephrostomy catheter is most times straightforward, providing immediate benefit for the patient and satisfaction for the practitioner, there can be situations that make the procedure more difficult or risky. A thorough review of the patient's imaging and medical record will help to set a path for success. However, there may be innuendos and unforeseen circumstances that occur. Having knowledge of most of these "stumbling blocks" and how to deal with them will keep you on the path. This paper serves to fill some of that mental file with the aim to increase clinical success.

Image-Guided Biliary Interventions: How to Recognize, Avoid, or Get Out of Trouble

Percutaneous biliary interventions have a well-established role in the management of hepatobiliary diseases. Good outcomes include recognizing and avoiding complications. This section will cover the "standard" technique of percutaneous biliary drainage, pearls to decrease the risk of problems, and approaches to treat those complications in patients undergoing percutaneous transhepatic cholangiography and percutaneous transhepatic biliary drainage.

A Multidisciplinary Approach to Pancreas Cancer in 2016: A Review

In this article, we review our multidisciplinary approach for patients with pancreatic cancer. Specifically, we review the epidemiology, diagnosis and staging, biliary drainage techniques, selection of patients for surgery, chemotherapy, radiation therapy, and discuss other palliative interventions. The areas of active research investigation and where our knowledge is limited are emphasized.

Prevention and treatment of septic shock following mini-percutaneous nephrolithotomy: a single-center retrospective study of 834 cases

PURPOSE

To explore the risk factors, prevention, and management of the septic shock following the mini-percutaneous nephrolithotripsy (mini-PCNL).

METHODS

A total of 834 consecutive patients who underwent mini-PCNL from June 2004 to April 2012 were retrospectively analyzed. The causes, prevention, and treatment of septic shock following mini-PCNL were assessed.

RESULTS

Twenty out of 834 patients developed septic shock, and 17 patients recovered without complications. Three patients progressed to multiple organ dysfunction syndromes and expired. Multivariable analysis showed that the following variables were independently related to septic shock following mini-PCNL: female, with an odds ratio (OR = 1.055E8, P < 0.001) and diabetes mellitus (OR = 4.192, P = 0.001).

CONCLUSION

Female and diabetes mellitus are the risk factors for septic shock following mini-PCNL. Perioperative preventive measures can reduce the incidence of septic shock. Early recognition and timely bundle treatment may decrease the mortality.

Prophylactic antibiotic guidelines in modern interventional radiology practice

Modern interventional radiology practice is continuously evolving. Developments include increases in the number of central venous catheter placements and tumor treatments (uterine fibroid therapy, radio- and chemoembolization of liver tumor, percutaneous radiofrequency and cryoablation), and new procedures such as abdominal aortic aneurysm stent-graft repair, vertebroplasty, kyphoplasty, and varicose vein therapies. There have also been recent advancements in standard biliary and urinary drainage procedures, percutaneous gastrointestinal feeding tube placement, and transjugular intrahepatic portosystemic shunts. Prophylactic antibiotics have become the standard of care in many departments, with little clinical data to support its wide acceptance. The rise in antibiotic-resistant strains of organisms in all hospitals worldwide have forced every department to question the use of prophylactic antibiotics. The authors review the evidence behind use of prophylactic antibiotics in standard interventional radiology procedures, as well as in newer procedures that have only recently been incorporated into interventional radiology practice.

Percutaneous transhepatic biliary drainage

Over the past three decades, endoscopic and percutaneous biliary drainage have become readily available in most hospital settings and these minimally invasive techniques have revolutionized the treatment of patients with biliary obstruction. In the past, treatment of biliary obstruction had required surgery under general anesthesia and an extended hospital stay. Currently, the same patient can most often be treated either endoscopically as an outpatient or during a short hospital stay after percutaneous drainage under moderate sedation. This article reviews the indications and technique of percutaneous transhepatic cholangiography and biliary drainage.

Sepsis in the interventional radiology patient

Sepsis is a problem frequently encountered by interventional radiologists since they are often asked to perform procedures on patients already septic. Occasionally, patients may become septic during interventional procedures. Both of these mandate interventionists be prepared to institute therapy and manage the patient through the procedure or until critical care teams can be mobilized. It is the purpose of this text to provide an outline for dealing with the septic patient in the interventional radiology setting.

Endoscopic stone surgery: minimizing the risk of post-operative sepsis

PURPOSE OF REVIEW

Urosepsis from manipulation of the urinary tract during stone surgery can be catastrophic despite antibiotic prophylaxis and sterile pre-operative urine. We have reviewed recent literature with regards to pathogenesis, predictors of infected stones and prevention of urosepsis.

RECENT FINDINGS

Bladder urine culture has been found to correlate poorly with infection in the upper urinary tract, defined by either stone or pelvic urine culture. This specimen, which has been the cornerstone in pre-operative preparation of patients, does not predict urosepsis. Authors recommending routine stone culture found that the presence of infected stones is highly predictive of potential sepsis. Terminology for systemic infection has been standardized and used in recent literature to define urosepsis.

SUMMARY

Recent studies have recommended changes in the approach to the peri-operative management of stone surgery. Predictors of potential sepsis have also been identified.