Ep. 453 Thoracentesis Best Practices with Dr. Paul Lewis

06/11/24 • 54 min

In this episode, Dr. Paul Lewis discusses best practices for thoracentesis. He shares insights on using image guidance, managing complex effusions, and managing complications such as pneumothorax and hemothorax. Dr. Lewis is an interventional radiologist at the University of Pittsburgh Medical Center.

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Laborie RenovaRP Centesis System

https://www.laborie.com/product/renovarp-products/

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SYNPOSIS

Dr. Lewis also speaks on patient selection, procedural techniques, equipment choices, and other troubleshooting tips. Additionally, the doctors cover procedural nuances such as bilateral thoracentesis and patient positioning and highlight the efficiency of the RenovaRP Centesis System.

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TIMESTAMPS

00:00 - Introduction

06:07 - Thoracentesis Procedure Walkthrough

16:49 - Equipment Used

22:14 - Troubleshooting

30:56 - Post-Procedural Care

36:12 - Complications

48:07 - Helpful Resources

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RESOURCES

Prospective comparison between a peristaltic pump and vacuum containers for paracentesis: Time, resources and safety:

https://pubmed.ncbi.nlm.nih.gov/38042055/

Paracentesis: Faster and easier using the RenovaRP® pump:

https://pubmed.ncbi.nlm.nih.gov/35548901/

Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions—Part II: Recommendations:

https://www.jvir.org/article/S1051-0443(19)30407-5/fulltext

The Impact of Gravity vs Suction-driven Therapeutic Thoracentesis on Pressure-related Complications: The GRAVITAS Multicenter Randomized Controlled Trial:

https://pubmed.ncbi.nlm.nih.gov/31711990/

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CHECK OUT OUR SPONSOR

Laborie RenovaRP Centesis System

https://www.laborie.com/product/renovarp-products/

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SYNPOSIS

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TIMESTAMPS

00:00 - Introduction

06:07 - Thoracentesis Procedure Walkthrough

16:49 - Equipment Used

22:14 - Troubleshooting

30:56 - Post-Procedural Care

36:12 - Complications

48:07 - Helpful Resources

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RESOURCES

Prospective comparison between a peristaltic pump and vacuum containers for paracentesis: Time, resources and safety:

https://pubmed.ncbi.nlm.nih.gov/38042055/

Paracentesis: Faster and easier using the RenovaRP® pump:

https://pubmed.ncbi.nlm.nih.gov/35548901/

https://www.jvir.org/article/S1051-0443(19)30407-5/fulltext

The Impact of Gravity vs Suction-driven Therapeutic Thoracentesis on Pressure-related Complications: The GRAVITAS Multicenter Randomized Controlled Trial:

https://pubmed.ncbi.nlm.nih.gov/31711990/

Previous Episode

Ep. 452 The 'Woundosome' Concept with Dr. Lorenzo Patrone

In this episode, Dr. Ally Baheti interviews interventional radiologist Dr. Lorenzo Patrone about his recent multidisciplinary editorial entitled "The 'Woundosome' Concept and Its Impact on Procedural Outcomes in Patients With Chronic Limb-Threatening Ischemia.”

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Reflow Medical

https://www.reflowmedical.com/

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SYNPOSIS

Dr. Patrone explains his interest in critical limb ischemia (CLI) and describes how he reached out to colleagues around the world with the intention of drafting a paper that summarizes research in below-the-ankle interventions and increases awareness of the woundosome concept.

He explains the woundosome concept, which aims to understand how each patient’s foot vasculature influences the effectiveness of below-the-ankle interventions and tissue healing. Understanding each patient’s anatomy, having adequate imaging of the foot, obtaining pedal acceleration times, and using micro-oxygen sensors are strategies to assess wound perfusion, which is integral for treatment planning and prognosis. He illustrates these techniques in a case study of a non-healing wound.

Finally, Dr. Patrone shares some technical tips for below-the-ankle interventions, including the benefits of ipsilateral antegrade access, sheath selection, and strategic contrast administration.

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TIMESTAMPS

00:00 - Introduction

02:25 - Multidisciplinary and Global Collaboration

05:59 - Explaining the Woundosome Concept

07:51 - Understanding Wound Perfusion

10:20 - Assessing the Effectiveness of Revascularization

20:09 - Case Example with Pictures

28:07 - Technical Tips for CLI Interventions

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RESOURCES

Find Your Algorithm (FYA):

https://fya-congress.com/

The "Woundosome" Concept and Its Impact on Procedural Outcomes in Patients With Chronic Limb-Threatening Ischemia:

https://journals.sagepub.com/doi/10.1177/15266028241231745?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

Vascular imaging of the foot: the first step toward endovascular recanalization (Manzi):

https://pubmed.ncbi.nlm.nih.gov/21997985/

BASIL-2 Trial:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00462-2/fulltext

BackTable VI Ep. 90- Pedal Acceleration Time for Limb Salvage with Jill Sommerset and Dr. Mary Constantino:

https://www.backtable.com/shows/vi/podcasts/90/pedal-acceleration-time-for-limb-salvage

The First-in-Man "Si Se Puede" Study for the use of micro-oxygen sensors (Montero-Baker):

https://pubmed.ncbi.nlm.nih.gov/26004327/

PEDRA Perfusion Monitoring:

https://www.pedratech.com/

Armada XT Balloon:

https://www.cardiovascular.abbott/us/en/hcp/products/peripheral-intervention/peripheral-dilatation-catheters/armada-14.html

Next Episode

Ep. 454 Moral Injury in Interventional Radiology with Dr. Mina Makary and Dr. Jeff Chick

In this episode of the BackTable Podcast, host Dr. Ally Baheti discusses the concept of moral injury with Dr. Mina Makary from Ohio State University and Dr. Jeff Chick from the University of Washington. The conversation focuses on their recent study published in Academic Radiology, which employed a survey to analyze prevalence of moral injury, factors contributing to its occurrence, and strategies to address it.

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RADPAD® Radiation Protection

https://www.radpad.com/

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SYNPOSIS

It is important to distinguish burnout from moral injury, with the former concept more focused on personal resilience, and the latter defined as extrinsic circumstances that lead to disconnection with one’s career. A key finding from the study was the negative correlation between degree of moral injury and quality of life. Respondents’ free text answers identified a variety of factors contributing to moral injury. The doctors also speak about strategies for addressing moral injury such as psychotherapy, spiritual care, and physical exercise. Most importantly, they believe it is crucial to target systemic factors with efforts to increase physician leadership, administrative support, and research in physician wellness.

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TIMESTAMPS

00:00 - Introduction

02:14 - Defining Moral Injury

05:31 - Survey Methodology and Respondent Demographics

07:52 - Key Survey Findings

11:07 - Causes of Moral Injury

12:11 - Personal and Systemic Strategies for Addressing Moral Injury

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RESOURCES

Moral Injury Among Interventional Radiologists (Woerner, 2024):

https://pubmed.ncbi.nlm.nih.gov/37926643/