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Tunneled Peritoneal Catheter Placement Under Sonographic and Fluoroscopic Guidance in the Palliative Treatment of Malignant Ascites

M. J. O'Neill1, Ralph Weissleder, Debra A. Gervais, Peter F. Hahn and Peter R. Mueller

1 All authors: Department of Radiology, Massachusetts General Hospital, White 270, 55 Fruit St., Boston, MA 02114.



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  		Fig. 1. —45-year-old woman undergoing placement of peritoneal catheter. Photograph shows catheter placement with guidance to identify fluid in right lower quadrant. Note lateral position of selected site for placement of 18-gauge Longdwell needle (insert); operator is dressed in sterile gown, and patient is draped in sterile covering to reduce possibility of infection.

 


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  		Fig. 2. —Method used to ease insertion of polymeric silicone peritoneal catheter. Photograph shows coaxial catheter system as it is pieced together. Coaxial system is used to prepare soft polymeric silicone peritoneal catheter for insertion into peritoneal cavity. Amplatz guidewire (Davis; Cook, Bloomington, IN) (arrowhead) is inserted through a long 5-French catheter (thin straight arrows); this combination is then inserted through polymeric silicone peritoneal catheter (thick straight arrow) to provide stiffness and reduce friction created by polymeric silicone catheter as it is pushed through peel-away sheath (curved arrow).

 


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  		Fig. 3. —Lateral-to-medial placement of tunnel. Photograph shows "tunneling" technique. Image of patient undergoing final placement of "cuffed" portion (straight arrow) of catheter. Special tunneling device (curved arrow) is used.

 

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