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IR Percutaneous Cholecystostomy

History/Indication for procedure: 72-year-old man with acute cholecystitis and complex medical history making him a poor surgical candidate. Please perform percutaneous cholecystostomy. Procedure: Ultrasound and fluoroscopically guided percutaneous cholecystostomy tube placement. Physicians: Complications: None. Medications: 1. 1% lidocaine local. 2. 1 mg Versed IV. 3. 50 mcg fentanyl IV. Contrast: 20 mL Omnipaque 300 nonionic contrast intra cholecystic. EBL: Less than 2ml Operative note and findings: The patient was counseled as to the risks, benefits, and alternatives to the procedure, and opted to proceed. Oral and written consent were obtained. The patient was placed supine on the interventional radiology table. Sedation was administered, the patient's state of consciousness and vital signs were monitored throughout the entire procedure, and sedation was discontinued at the conclusion of the procedure by the sedation nurse. The patient's distended gallbladder as well as and appropriate subhepatic access tract was evaluated using ultrasound. The access site was anesthetized using 1% lidocaine. Under ultrasound guidance, the gallbladder was punctured using an 21-gauge AccuStick access needle. Approximately 40 ml of nonpurulent but heavily sedimented bile was drained. Non-foul smelling. Samples of this bile were sent for culture. A 0.018 inch wire was then advanced and seen within the gallbladder fluoroscopically. A cholecystogram was performed, showing a uniformly dilated gallbladder without visualization of the cystic duct. A 0.035 inch Amplatz wire was advanced coaxially within the gall bladder alongside the 0.018" wire. The 0.018 inch wire was maintained as a safety wire. Under fluoroscopic guidance, an 8 French 30 centimeter Navarre drainage catheter was advanced to the level the gallbladder fossa. The cope loop was formed and locked. Postplacement cholecystogram confirmed intra cholecystic positioning. An additional 60 mL of bile was then aspirated from the gallbladder and discarded. The catheter was then secured with percutaneous sutures as well as a hemostatic dressing. The catheter was left to gravity drainage. The patient tolerated the procedure well, and was transferred back to the recovery unit in good condition. There were no complications. Impression: Status post technically successful percutaneous cholecystostomy. Plan: 1. Flush tube TID with 10ml sterile water or saline. 2. If tube removal is desired, tube cannot be removed sooner than 6 weeks in addition to tract evaluation under fluoroscopy to ensure tract durability.