This advertorial is sponsored by Argon Medical Devices
Placing a drain is an important, quotidian, “bread and butter” procedure that often has a tremendous impact on patients’ lives. “A drain is a drain until it is not,” says Sean Calhoun, who outlines the benefits of the Skater all-purpose, nephrostomy and biliary drainage catheters (Argon Medical Devices). He hones in on their anti-kinking and locking mechanisms, ease of insertion and transition and compatibility with both alcohol and doxycycline. Calhoun also shares his excitement about the recent commercial launch of the Skater mini-loop drainage catheters in the USA and the European Union, telling Interventional News: “I am hopeful that this will eliminate the problem of losing access to the abscess cavity by having the catheter track smoothly through the wall and into a small cavity. It is also going to be very helpful for external biliary drains.”
“The Skater drainage catheter is consistent, reliable, extremely easy to use and is visualised well under fluoroscopy due to its good radiopacity,” says Calhoun, vice chair of the Radiology Department and an interventional radiologist, Atlantic Health System, Morristown, USA. “Additionally, the locking mechanism is simple, intuitive and designed for patient comfort in that it is not bulky. The break-off tab is very easy to use and very easy to undo when it is time to remove the catheter—these catheters are also perceived to have excellent patency rates, which are the key features for any drainage catheter,” he adds.
Drainage is often seen as a quotidian, relatively routine procedure, with interventional radiologists placing five to 10 drainage catheters a week under different imaging modalities depending on the location. Drains are placed under imaging guidance for a wide variety of indications, including abscesses, biliary and ureteral obstructions, pleural effusions and pneumothoraces, Calhoun, who is also programme director for the Radiology Residency, indicates.
An important point he emphasises is that while a drain is seen as a standard piece of equipment, there are subtle differences that are not appreciated until you have a drain that fails, commenting that “a drain is a drain until it is not”. This is when you really appreciate the differences in the technology and design and the many advantages offered by drains such as Skater, he notes. Calhoun particularly draws attention to the hydrophilic coating, resistance to kinking and accordioning—three things that contribute to the ease of insertion and the reliability of the device.
“During insertion, drains can certainly accordion because the multiple side holes create a relative weakness in the catheter. I have had catheters in the past in which the side holes accordion, particularly in tight biliary strictures. This makes it very difficult to advance the drain. The Skater catheter seems to track very well through firm cirrhotic livers. When using other catheters in the past where there was challenging cirrhotic liver and a tight stricture, I recall going through several catheters that just continually weakened; that has almost never been the case with the Skater line. Those difficult situations now seem like distant memories, because we have been using this product for 10 years.
“The concept of durability and not having the catheter break down necessitates patients having to come in for avoidable changes, particularly when we start using the catheters for things like lymphocoele sclerosis and cyst sclerosis with alcohol, during which some catheters can break down and fragment. I have also seen patients come in with their catheters in all sorts of disarray; they can have kinks, be twisted and become occlusive. While many patients keep them in pristine condition, others do not, and we have observed that the catheter is twisted and wrapped around and coiled under a dressing that has not been well cared for, oftentimes with the catheter not draining in that situation. This might lead the physician to believe that the catheter is occluded, but in fact, there is a kink in the catheter under the dressing; we have seen that with other manufacturers in the past. The Skater catheter appears to be much more resistant to kinking.”
Skater is compatible with both doxycycline and alcohol
One major advantage of the Skater catheter is that it is compatible with both alcohol and doxycycline. Calhoun explains why this dual compatibility is important: “Patients who have undergone drainage of a symptomatic cyst, a symptomatic renal cyst, or a hepatic cyst, or postoperative lymphocoele, will often be sclerosed to avoid cyst recurrence or promote healing. The primary compound that we use is alcohol, but doxycycline is another popular alternative these days with alcohol becoming less available due to manufacturing shortages. Many of the other non-compatible catheters will break down during this sclerosing procedure. You hear horror stories of interventional radiologists chasing catheter fragments in the cyst cavity, and trying to retrieve them can be very difficult. Fragmentation is not only cumbersome, it puts the patient at risk. So, being able to confidently use alcohol, or doxycycline, knowing that the catheter is going to stay intact is huge,” Calhoun elaborates.
He also calls out the flow rates as being important. “The fact that the Skater catheter has a consistent lumen even at the hub means that you avoid the problem of effectively putting in a smaller catheter than what you think you are putting in.”
Biliary drains and occlusions
Biliary drains can frequently be “management headaches” as patients, who are very sick with sepsis and life-threatening infections, can come in with occlusions. Early occlusions are very problematic for patients as they can lead to life-threatening infections. Other times it is just an inconvenience for the patient, notes Calhoun. “If there is poor drainage, it is often due to occlusion of the catheter side holes, so I think the skived side holes of the biliary drainage catheters certainly help to reduce the occlusion rates. All catheters are going to be subject to some rate of reocclusion, but it has been our perception that the Skater catheters have a much lower rate of early occlusion than some of the other catheters that we have used in the past.”
Skater mini-loop launch received with enthusiasm
Commenting on the recent commercial launch of the Skater mini loop catheter, an expansion of Argon’s Skater all-purpose and nephrostomy drainage portfolio, which uses a 40% smaller loop to help secure the catheter and drain fluid from smaller cavities, Calhoun says: “I have often been disappointed with the mini pigtail catheters available because the transition at the tip is unfortunately not ideal to get into a small abscess cavity. In these small cavities, you do not have a lot of guidewire purchase, so you want the catheter to track smoothly and easily through the wall, so that you can situate it without losing purchase. In my experience the transition is much smoother and uniform with the Skater range than the other catheters out there, so I am hopeful that this will eliminate that problem. It is also going to be very helpful for external biliary drains. If it performs the same as the other catheters in terms of drainage and reliability, then we have hit a home run.”
Product support and availability matter
While the pandemic seems to have impacted the availability of product ranges across the board, the Skater device has been relatively unaffected. “My technologists are regularly flagging back orders. Matters can come to a head when a patient is already here, and we have to pivot to find other alternatives. That has not been the case with Skater catheters, or any of the Argon products, which are all manufactured in the USA. They have always been available and the product support has been excellent. We have expanded our Skater inventory as there are multiple sizes and diameters available. We can always count on that catheter being on the shelf and having plenty of stock and it has now become our go-to product,” says Calhoun.