Quality Improvement Guidelines for SIR Procedures

A specific level of an indicator for a procedure, used to assess quality improvement programs.

A program to assess and improve the efficacy of procedures

A minimum acceptable rate of procedure success (or maximum complication rate)

Procedure to drain gall bladder contents, to be done via a needle or tube

Successful completion of the procedure without major complications

The number of times sepsis occurs after a procedure, used to measure how well the procedure is performed.

A predetermined level of success for a procedure, below which improvements are needed.

Different patient populations, referral patterns, and institutions have varying needs and standards, so a universal threshold is not suitable.

To continuously improve the quality of procedures and lower the rate of complications.

Monitoring and managing patients who have had a cholecystostomy to ensure their recovery and address any complications.

Inflammation of the gallbladder without gallstones, often occurring in critically ill patients.

Individuals with significant health risks making surgery extremely difficult or dangerous, often requiring alternative treatments.

The process of maintaining and caring for the drainage tube after a percutaneous cholecystostomy procedure.

Potential issues arising from the procedure, such as bleeding, infection, or tube displacement.

A method of draining the gallbladder by inserting a tube through the liver and into the gallbladder.

A method of draining the gallbladder by inserting a tube through the abdomen and into the gallbladder.

Infection of the abdominal lining caused by bile leaking from the gallbladder.

Infection of the lungs by bile leaking through the liver.

Bleeding inside the gallbladder caused by injury during the procedure.

Ultrasound is preferred to guide cholecystostomy, except for significantly diseased gallbladders. In these cases, CT can be used, as it can identify a ruptured gallbladder even when ultrasound cannot.

The Accustick II introducer system and Neff percutaneous access set allow you to increase the wire size from 0.018 inches to 0.035 inches for cholecystostomy. This may be helpful for larger gallstones or difficult access.

After the needle is inserted into the gallbladder under ultrasound guidance, a guidewire is placed within the lumen, securing access for drainage.

After the guidewire is secured in the gallbladder lumen, the needle is removed. Then, a series of dilators are used to widen the access point for drainage.

While ultrasound is used to initially guide the needle placement, fluoroscopy is commonly used to guide catheter insertion during cholecystostomy.

A procedure where a tube is placed into the gallbladder to drain its contents, often done when surgery is too risky.

Percutaneous means 'through the skin.' In cholecystostomy, it means the tube is inserted through the skin.

Potential complications include bleeding, infection, tube displacement, bile leaking into the abdomen or lungs, and damage to surrounding organs.

Fluoroscopy uses X-rays to guide the placement of the tube into the gallbladder, ensuring accuracy and avoiding damage to nearby organs.

Cholecystostomy is a good option for patients with serious health problems or who are too weak for surgery, especially if their gallbladder is inflamed and needs drainage.

Inflammation of the gallbladder, often caused by gallstones. It can lead to pain, fever, and nausea.

Surgical removal of the gallbladder, the standard treatment for acute cholecystitis.

A procedure where a tube is inserted through the skin and into the gallbladder to drain bile, an alternative to surgery for high-risk patients.

In emergent situations like gangrene, emphysematous cholecystitis, necrosis, perforation, abscess, or worsening clinical status despite supportive therapy, cholecystectomy is necessary.

A study showed that in severe cases of acute cholecystitis with shock and sepsis, cholecystectomy significantly improved survival compared to PC.

A diagnostic test using radioactive tracers and morphine to detect gallbladder inflammation. It's rarely used due to a high false-positive rate.

A finding on a CT scan that shows enhanced blood flow around the gallbladder, indicating inflammation in acute cholecystitis.

Magnetic Resonance Imaging (MRI) can be used to diagnose acute cholecystitis, providing similar accuracy to ultrasound. However, its cost and availability limit its use.

A finding on contrast-enhanced MR images that shows a gap in the gallbladder's lining, suggesting possible gangrene or perforation.

Magnetic Resonance Cholangiopancreatography (MRCP) is helpful for detecting stones in the bile duct and differentiating them from Mirizzi syndrome.

Inflammation of the gallbladder, often caused by gallstones. It can lead to pain, fever, and nausea.

Guidelines for managing acute cholecystitis, defining severity levels and treatment recommendations.

A minimally invasive surgical procedure to remove the gallbladder.

A tool to assess a patient's overall health status and the risk of complications during surgery.

A medical classification system to assess a patient's physical condition before surgery.

Cholecystostomy (PC), a procedure to drain the gallbladder, is recommended when surgery is too risky for the patient, like in cases of severe illness or high-risk status.

The 'CT Rim Sign' is a finding on a CT scan where there is increased blood flow around the gallbladder. This indicates inflammation and provides a strong indication that the patient has acute cholecystitis.

Morphine helps increase the pressure gradient in the gallbladder, allowing the radioactive tracer to concentrate more effectively. This aids in diagnosing acute cholecystitis.

A study found that patients with severe acute cholecystitis, experiencing shock and sepsis, had better survival rates when they underwent a cholecystectomy (surgery to remove the gallbladder) compared to PC (gallbladder drainage).

When planning a cholecystostomy, factors like ascites (fluid buildup in the abdomen), bowel loops near the gallbladder, and the position of the diaphragm should be taken into account. These anatomical details can affect the procedure's safety and success.

A procedure where a tube is inserted into the gallbladder to drain its contents, often used when surgery is too risky for the patient.

Patients with serious medical conditions making surgery risky, requiring alternative procedures like cholecystostomy.

Surgical removal of the gallbladder done immediately in life-threatening situations like gangrene or perforation.

Percutaneous cholecystostomy (PC) is often used for patients who are considered too high-risk for surgery, such as those with severe illness or multiple medical conditions.

Cholecystostomy is a temporary solution for draining bile from the gallbladder in patients who cannot undergo surgery due to high risk.

After a cholecystostomy, there's a 10-20% chance of gallstones returning within the first few years, making a definitive surgery necessary.

Cholecystectomy, the removal of the gallbladder, is the preferred treatment for acute cholecystitis in stable patients because it eliminates the risk of future recurrence.

There's a lack of quality research comparing cholecystostomy and surgical removal for acute cholecystitis. Large studies often combine diverse patient groups, making results inconclusive.

The effectiveness of cholecystostomy in preventing future gallstones remains unclear. Long-term studies are needed to evaluate its long-term impact.

Potential complications include bleeding, infection, tube displacement, bile leakage into the abdomen or lungs, and damage to surrounding organs.

Cholecystostomy is a safer alternative to surgery for patients with serious health conditions, like instability or multiple medical problems.

Studies by Garber et al. (1994) and Loberant et al. (2010) showed that cholecystostomy is a safe procedure with no evidence of significant complications.

Two methods used to place the drainage tube. The trocar technique is simpler, using a pointed instrument to create an opening. The Seldinger technique is more precise, using a needle and guidewire.

Potential complications include bleeding, infection, tube displacement, and bile leaking into the abdomen or lungs.

Two primary approaches include transperitoneal (through the abdomen) and transhepatic (through the liver).

Factors like the patient's age, medical history, and the presence of stones in the gallbladder influence the choice of procedure.

A procedure where a tube is inserted through the skin and into the gallbladder to drain bile, an alternative to surgery for high-risk patients.

Two techniques for inserting the drainage tube. Seldinger uses a needle and guidewire for precision, while trocar is simpler and uses a pointed instrument.

Ultrasound is preferred to guide PC unless the gallbladder is severely diseased. In those cases, CT allows visualization of a ruptured gallbladder, which ultrasound can't always detect.

Patients are monitored closely for 4-6 hours, usually under intensive care. Hydration and antibiotics are provided.

CT-guided PC has shown a greater success rate than ultrasound-guided PC, but the choice of guidance is based on the radiologist's preference.

PC is typically used for high-risk patients who cannot undergo surgery due to medical conditions, severe illness or fragility.

PC aims to relieve pressure and inflammation in the gallbladder by draining the accumulated bile, providing temporary relief.

PC can be performed using a transperitoneal approach (through the abdomen) or a transhepatic approach (through the liver).