Trocar technique

Fig. 37.10a,b. Patient with spondylodiscitis and bilateral psoas abscesses. With a lateral approach along the iliac crest (a), an 8-French drainage catheter was placed in both abscesses under CTF guidance using the Trocar technique (b)... 

Pleural Effusion. The basic indication for drainage of pleural fluid collections is dyspnea in patients with malignant pleural effusions, while benign parapneumonic effusions are drained only exceptionally. Thoracocentesis can be performed with a small intravenous cannula as a temporary solution, or a small drainage catheter (8 French) using either the Seldinger or Trocar technique. The drainage catheter is connected to a three-way-stop-cock and a sterile evacuated bottle that drains the effusion continuously. 

Trocar technique for easy-to-access fluid collections Seldinger technique for more sophisticated, i.e., deep or small fluid collections adjacent to neurovascular structures or bowels Sump and non-sump catheters Diameter of suitable drainage catheter (8-28 French) depends on viscosity of fluid and size of fluid collection. 

To monitor arterial blood pressure, a 4 cm incision is made over the right femoral region and the femoral artery is isolated. A trocar is used to pass the blood pressure catheter from the abdomen to the femoral incision. An arterotomy is made in the femoral artery and the catheter introduced 10 cm into the artery and the catheter secured using standard techniques. 

One of the application segments that is commonly associated with polymer blends is that of surgical instruments. As surgical techniques have proliferated, so has the need for increasingly specialized instruments. The drive toward minimally invasive surgeries has created the need for miniaturization, which in turn drives the need for smaller components with sufficient strength and durability. Access devices that are appropriate for polymer blends include trocars, retractors, and speculums. Hand instruments include staplers and forceps. Thermal ablation and electrosurgi-cal techniques require powered instruments. 

Table 37.5. Advantages and disadvantages of the Trocar and the Seldinger techniques...

Surgical placement of a PD catheter can be done using an open or a laparoscopic method [20-22]. There are no clear data to suggest that one approach is superior to the other. Patient safety, surgical complications and catheter function rates have not been shown to be different depending upon the method used for placement (table 1). It has been reported that the laparoscopic method is more time consuming and somewhat more expensive (especially if disposable trocars are used), implying that the open technique maybe more cost-effective [22]. The functional outcome of the PD catheter is not different when placed either by open or laparoscopic methods. 

For blind percutaneous placement, a large bore trocar is used after provision of local anesthesia. The technique was first developed and described by Tenckhofif. The method is simple and can be performed at bedside. Disadvantages of this method are the inability to effectively tunnel a dual cuff catheter and because it is a blind procedure, therefore subjecting the patient to potentially increased risks of vascular, bowel, or solid organ injury. 

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