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Interventional Radiology: Percutaneous Transhepatic Biliary Drainage - Interventional Radiology (4608)

Interventional Radiology: Percutaneous Transhepatic Biliary Drainage - Interventional Radiology (4608) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, Radiology - Invasive Procedures

4608

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Percutaneous Transhepatic Biliary Drainage
Interventional Radiology


Your doctor has scheduled a percutaneous
transhepatic biliary drainage to be done in
the Interventional Radiology (IR)
Department on___________________
at ____________AM/PM.

This handout explains the procedure and
what you need to do before and after it is
done.

What Is a Percutaneous Transhepatic
Biliary Drainage?

This is an x-ray procedure in which a small
needle is placed through your skin on your
right side. This small needle is moved into
your liver. The needle is replaced by a
flexible tube or catheter. The use of contrast
(x-ray dye) helps the doctor see the bile
ducts when placing this tube.

Why Do You Need This Procedure?

1. If you have a blockage of the bile ducts,
this can show where the blockage is,
how severe the blockage is, and what has
caused it.

2. It can be used to make some patients
with long-term blockage more
comfortable.


3. Sometimes it is done to prepare for
surgery. It can help the doctors see
where the bile duct problems are so they
know where to operate later.

4. If there has been trauma to the bile ducts
such as a hole made by an injury, it can
help prevent complications or control
pain and infection.

5. Sometimes it is a way to insert an
internal stent (a device to open up
narrowed ducts).

6. When patients have a bile infection
(cholangitis) it is sometimes part of the
treatment to drain the infected bile.

The tube may be left in for a few days or
permanently. It depends on the reason you
need the tube placed. Patients who have bile
drainage tubes placed need to have them
changed in our department every 6-8 weeks.
Sometimes they are removed earlier than
that. We will make a follow-up visit for you
when the tube needs to be changed.









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How do I Prepare?

1. If you take a blood thinner daily, the
Interventional Radiology staff will
contact you and tell you when you
should stop taking your blood thinner.

2. Do not eat anything after midnight. You
may take your normal morning
medicines with a sip of water.

3. If you are taking insulin, our staff will
give you instructions on how to adjust
the dose before the procedure. Test your
blood sugar in the morning before
coming to the radiology department. We
will also recheck your blood sugar.

4. You will need to have blood work before
the procedure. Often, this will be done
the morning of your procedure at the
hospital.

5. Plan to stay in the hospital for at least 24
hours after the exam so that we can
watch you closely.

6. If you are pregnant or think you may be
pregnant, please tell the Radiologist.

7. Be sure to tell the Radiologist if you
have any allergies to contrast dyes,
antibiotics, anesthetic agents, or any
other medicines that you may have taken
before. Tell the Radiologist if you are
allergic to Iodine or Latex.

How Is the Procedure Done?

It is done in the IR Department. Before we
begin, the doctors will explain the procedure
to you and ask for your consent to do it.
Again, be sure to tell the doctors if you
have any allergies to contrast dyes,
antibiotics, anesthetic agents, latex, or any
other medicines you may have taken before.

An intravenous (IV) catheter will be started
and you will be given IV fluid and an
antibiotic.

Based on clinical presentation, the procedure
is done with either heavy sedatives and pain
medicine given by an anesthesiologist
(general anesthesia) or conscious sedation
given by an IR RN.


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The needle and the tube are placed using

Ultrasound to show deep structures in the body by recording the echoes of sound waves.

Fluoroscopy, an exam of deep structures by means of x-rays.

After review of your x-rays and the use of the above techniques, the doctor will mark the area on
your right side. Your skin will be cleaned with soap. You will be covered with sterile drapes to
help prevent infection. The doctors will wear sterile gowns and masks.

Using fluoroscopy, a small needle is placed in the liver. The doctors will remove the needle and
replace it with a soft tube (catheter) in the bile duct that needs to be studied. After placing the
tube into the bile duct, a small amount of contrast (x-ray dye) will be given to see how bile flows.
Fluoroscopy will be used to see the ducts when the contrast goes in. The pictures below show
how the tube is placed:

(A) Needle placed into liver and bile duct.











(B) A guidewire is passed through the needle and down into the bile ducts.















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(C) The needle will be removed from the bile ducts and liver through the guide wire.











(D) The soft plastic biliary tube catheter will be passed over the guidewire and into the bile ducts.











The other end of the bile tube may remain outside your body to drain bile into a bag. If this is the
case, the bile tube is fastened at the skin surface with stitches. A dressing is placed over the tube
and kept in place with tape.



What Should I Expect after the
Procedure?

1. You will be moved to the recovery room
for close monitoring. Once you wake up
from the sedatives, you will return to a
hospital room where you will rest and
recover for 4-6 hours.

2. Nurses will check your vital signs: pulse,
blood pressure, and temperature.

3. Nurses will check the amount and color
of the bile that drains from the tube.




4. You should tell the nurses if you feel
 nausea
 fever or chills
 good deal of pain at the tube site
 trouble taking in a deep breath or feel
shortness of breath

How do I care for myself at home?

Most patients are sent home with the
drainage tube in place. It is very important
that you know how to care for the tube once
you are home.



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The dressing should be changed every 3
days. The tube site is cleaned when the
dressing is changed. Mild soap and water is
used to clean the site. Then, a small sterile
gauze should be placed over the site and
covered with a Tegaderm™ dressing.

If your skin is sensitive to the Tegaderm™
dressing, you will follow the same steps, but
the gauze can be taped in place. In this case
the dressing needs to be changed daily.

How do I change the dressing?

1. Gather all supplies needed.
ξ Mild soap( ie: Dove)
ξ sterile 2x2 gauze dressings
ξ medium size Tegaderm™
ξ Clear adhesive tape or paper tape (if
sensitive to Tegaderm™)
ξ Drainage bags (only if needed
otherwise change every 2-4 weeks)
ξ Extension tubing (CTU-14 change
only if needed otherwise change
every 2-4 weeks)
ξ Blue Caps for flushing and capping
trial

2. Wash hands well with soap and water for
30 seconds.

3. Open the sterile 2x2 gauze, and
Tegaderm™.

4. Remove the old dressing.

5. Check the tube site for signs of infection:
ξ increased tenderness or pain
ξ increased redness or swelling
ξ drainage that is green in color or has
a bad smell

6. Check that the stitches at the skin site are
still tight and not loose.

7. Using a clean washcloth, clean the skin
around the tube site with soap and water.
ξ Gently wash the skin around the exit
site. Rinse site with wet washcloth
ξ Wipe dry
ξ Allow the area to dry completely
before putting the dressing on.

8. Place the folded sterile 2x2 gauze
underneath the tube as well as over the site.

9. Cover the gauze with the Tegaderm™
dressing.

What Should I Do If My Biliary Drainage
Tube Is Connected to a Drainage Bag?

The tube can either be connected to a
drainage bag or just capped off. You will be
told how your tube should be.

If the tube connects to a bag it should drain
greenish bile. The bag should be placed so
that it is at waist level or lower. This helps
the bile to drain. The extension tubing and
drainage bag will be changed when you
come to the hospital to change the tube.

If the tube is capped off, it will not drain
bile. There will be a little cap at the end of
the tube. In this case you only have to
change the dressing.

Instructions for self capping at home within
24-48 hours:
 Turn stopcock towards your body
 Leave the bag in place for several
hours. If you do not have a fever, chills,
or pain, you can disconnect the bag
from the stopcock, and attach blue cap.
 If you do have fever, chills, or pain, re
open the bag to drain or reattach tubing
and bag if removed.
 Once bag is removed, place blue cap at
the end of stopcock



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 You should continue to flush tube as
previously instructed.

**If you fail the capping trial, please call the
Radiology Department at 608-263-9729

The tube needs to be flushed each day. You
will be given a sheet telling you how to flush
your drain (Health Facts for You #5721 –
Flushing Your Drain).

When Should I call the doctor?

 Redness at the site.
 Greenish drainage at the site.
 Significant swelling at the site.



 If you have a fever greater than
100.4 θ F (38 θ C). Take your
temperature if you are not feeling
well.
 A decreased amount or no bile
drainage from the tube.
 Pain at the tube site or in your side
where the tube has been placed that
does not go away with pain
medicine.
 The stitches at the site come undone.
 The tube falls out.
 Severe nausea, vomiting, or diarrhea.







Phone Numbers

If you have any questions or problems once you are at home, call the Radiology Department
(608) 263-9729 opt #3 Monday through Friday, 8:00 am to 4:30 pm

Evenings, weekends, and holidays call the paging operator at (608) 262-0486 to reach the
Interventional Radiologist on call. Give the paging operator your name and phone number with
the area code. The doctor will call you back.

If you live out of the area, please call 1-800-323-8942.










Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright ©9/2016. University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#4608