1. Drainage catheters and biopsy needles John Hancock IR-TB April 2007

2. RCR IR curriculum ‘Biopsy and fluid drainage techniques are practised by all radiologists and are not included in this curriculum’

3. Patient prep. Consent Anaesthesia/sedation Image guidance Techniques Aftercare

4. Drains

5. Will aspiration do? Type Size Approach/position Guidance Fixation

6. Type Pigtail or pigtail? Locking or non-locking? Sump? Number?

7. Size? Thin fluid6 – 8 Fr Thin pus 8 – 10 Fr Thick pus10 – 12 Fr Up to 20Fr+

8. Technique Needle, then… One step, one stick, or Two step over guidewire

18. Biopsy Needle type Image guidance Techniques –Coaxial –Transjugular –Plugged

19. Gauge Based on the Stubs Iron Wire Gauge measurement Inversely proportional and non-linear (thanks)

20. Aspiration cytology Fine needle 21 or 22g Chiba Safe Limited application – cells not tissue

21. Cutting needles Many types 14g to 18g Length of throw (variable) Core of tissue Manual Automated/‘programmable’ Side notch End cut

38. Familiarise yourself

39. This is my biopsy gun There are many like it but this one is mine My gun is my best friend I must master it as I must master my life My gun without me is useless Without my gun I am useless I must aim my gun true

41. Specimens Size (renal and lymphoma) Don’t forget microbiology They’re your responsibility