Lymphocele Drainage

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Lymphocele is a complication which will be familiar to the gynecological surgeon, particularly the oncologist. It is also well recognized in association with urological pelvic surgery and renal transplantation. Occurrence of lymphocele has been described in relation to surgery in a wide variety of other areas including the mediastinum, axilla, neck, aorta and peripheral vasculature.

Percutaneous drainage is the technique for draining fluid colections in most body locations. Drain placement is one of the major minimally invasive advances in patient management. This is an image guided procedure. It can be performed with ultrasound or CT fluoroscopic image guidance

Need to Know

Nice to Know
  • You will be asked to sign a consent form before the procedure is performed
  • Do not eat or drink anything at least eight hours before the procedure
  • Tell your radiologist about any allergies, especially to local or general anesthetics and contrast materials (“x-ray dye”)
  • Bring a list of medications you are currently taking and their dosages
  • If you are taking a blood thinner or aspirin product, the physician will instruct you when to stop taking these medications
  • If you are diabetic, the physician will give you insulin and/or anti-diabetic medication dosing instructions
  • Inform your radiologist if you are pregnant
  • You should plan to have someone take you home after the procedure
  • Before your procedure, you will meet with your Jefferson Radiology Physician or mid-level provider for a consultation
  • Wear comfortable, loose-fitting clothing
  • You will be given a gown to wear during your treatment
  • You will be relaxed during the procedure and can go home after a recovery period
  • Most patients feel minimal discomfort after the procedure

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How Does It Work?

There are various catheters available for drainage. The decision to drain a lymphocele under ultrasound or CT guidance is based largely on the location of the lymphocele, the size, and operator preference. A catheter will be placed in the collection. The content in the collection will be aspirated and drained into a drainage bag that will be connected to the catheter. The catheter will be secured to the skin or a commercially available catheter fixation device will be used.

What Happens — Before, During, and After?

A clinical staff member will bring you into the pre-procedure area and ask you to change into a gown. An intravenous (IV) line will be inserted into a vein in your hand or arm. Your doctor will greet you, review the procedure, and answer any questions you may have. You will be brought into the procedure room, and you‘ll be positioned on the procedure table. You will be connected to a monitor for your heart rate, blood pressure, and pulse.

The technologist will shave, sterilize, and cover the area of your body where the catheter will be inserted with a surgical drape. A local anesthetic is administered to numb the area where the catheter will be placed. Once the area is numb, your doctor or mid-level provider will make a small incision and using image guidance insert a needle into the lymphocele. You might feel some pressure as the wire and catheter are inserted but you should not feel any serious discomfort. Once the collection is accessed a catheter will be placed and left to drain the fluid collection. The catheter will be secured to your skin. A drainage bag will be attached to the catheter. The procedure takes approximately 1 hour.

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How Should I Prepare?

There are things you can do to make your experience more comfortable, and many of these will depend on your individual preferences. You might like to keep a list of questions or – as you’re doing now- educate yourself about the procedure.

You will need to get a blood test to check your liver and kidney functions.

Another important part of your preparation will be guided by your doctor:

  • Your doctor may ask you to stop taking aspirin, non-steroidal anti-inflammatory drugs (NSAIDS), or blood thinners (such as Coumadin, Warfarin, Plavix, Fragmin) for a time before the procedure.

Some of your preparation will need to be timed to the procedure:

  • The day before the procedure (or the Friday before, if you’re scheduled for a Monday procedure), a clinical staff member from the Interventional Radiology Department will call you. The clinical staff member will give you any additional instructions, and will ask if you have any questions.
  • In the 8 hours before the procedure, do not drink fluids or eat food.
  • You may take the medications with a sip of water
  • When you arrive, make sure the clinical staff member and radiologist know about any allergies you may have, especially allergies to local anesthetics (such as lidocaine), general anesthetics, or x-ray dye (contrast media). If there’s any chance you might be pregnant, tell your radiologist.
 
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What Should I Bring?

  • Wear comfortable, loose-fitting clothes
  • Wear comfortable shoes
  • A list of your current medications with dosages
  • Avoid bringing jewelry or valuables
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What Are the Benefits and Risks?

The benefits of Lymphocele Drainage include:

  • Minimally invasive procedure
  • Decrease pain and discomfort
  • Decrease ureteral obstructions

Risks you should be aware of include:

  • Like any catheterization procedure, there is risk of damage to blood vessels, bruising, bleeding, or infection at the puncture site

Keep in mind that this information is general. Your radiologist is the best source of information about how these risks and benefits may apply to you.

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