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Clinical Hub,Patient Education,Health and Nutrition Facts For You,Radiology - Invasive Procedures

Preparing for Your Transjugular Intrahepatic Portosystemic Shunt Placement (TIPS Procedure) (4640)

Preparing for Your Transjugular Intrahepatic Portosystemic Shunt Placement (TIPS Procedure) (4640) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, Radiology - Invasive Procedures

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Preparing for Your Transjugular Intrahepatic
Portosystemic Shunt Placement (TIPS Procedure)


This handout tells you how to prepare for a transjugular intrahepatic portosystemic shunt (TIPS)
placement. This procedure is done in the Interventional Radiology Department.


What is a TIPS?

A TIPS placement is done to allow blood to flow more freely through the liver back to your
heart. It creates a new pathway between two main veins in your liver. A metal stent is placed in
the pathway to keep it open.

Why do you need a TIPS?

1. To decrease the amount of fluid in the abdomen (ascites). TIPS is helpful when other
attempts to decrease the amount of fluid in the abdomen have failed.
2. To lower the risk of GI bleeding (bleeding into the stomach or intestines). If you have
had problems with GI bleeding, you may need a TIPS to lower the risk of life threatening
bleeding.

The liver has many jobs. One of its jobs is to filter the blood. The liver has many small blood
vessels that bring blood through the liver to filter out toxins. When a person has scarring in the
liver (cirrhosis) the blood cannot flow through the liver as well as it should. This can lead to a
build up of pressure in the veins leading into the liver. If the pressure is high enough, these veins
can bleed (GI bleeding) and fluid from these veins can leak into the abdomen (ascites).

When a TIPS is done, a new path is created in the liver to allow blood to flow through the liver
better. The intent of a TIPS is to reduce the risk of GI bleeding and the amount of ascites fluid.
The TIPS will not help the liver work better though. So if the liver has problems with its other
jobs, such as helping blood to clot, filtering toxins or helping with digestion, you will still have
those problems after the TIPS.

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TIPS - How is it Done?

These pictures show how the TIPS is done. With the assistance of
anesthesia, you will be asleep during the TIPS. The whole procedure
is done using fluoroscopy, real time x-ray on TV screens to guide the
interventional radiologist.


Insertion of a small needle
into the R internal jugular
vein





A. After the insertion of a
small needle into the R
internal jugular vein, the
needle and guidewire
are advanced into the
hepatic vein.





B. A guiding needle is pushed in an attempt to “create
the path” to get into a branch of the portal vein.









C. The guidewire is advanced into the portal vein
further to maintain access.




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D. The guidewire is advanced into the portal
venous system to maintain access.













E. A balloon dilation or “angioplasty” is done
to widen the newly created pathway.









F. The metallic stent is inserted and positioned
in the new pathway between the hepatic vein
and portal vein.









G. A re-dilation of the stent just placed
improves the capacity of blood flow through
this area.

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What are the Risks?

1. Life threatening bleeding in the liver
2. Infection
3. Heart failure
4. Worsening liver failure
5. Increase in confusion (encephalopathy)
6. Kidney problems

The Interventional Radiology team will talk
to you in detail about the risks before your
TIPS is done. After you are aware of the
risks, you will be asked to sign a consent
form to have the TIPS.

Before the TIPS

To prepare for the TIPS, a number of tests
and procedures may be done. You may
have these tests ahead of time or on the day
you come to the hospital.

ξ Blood tests - To measure how well
your liver and kidneys are working
and how well your blood clots.
ξ CAT scan or ultrasound of your
abdomen – To help the doctors plan
where to insert the TIPS.
ξ Paracentesis – If you have fluid in
your abdomen (ascites). To test the
fluid for infection. If there is
infection, it must be treated before
the TIPS.
ξ Echocardiogram – to measure how
strong your heart is. This will help
find out if your chance of heart
failure is low enough to do the TIPS
safely.

If you are taking “blood thinning” medicines
(aspirin, Plavix , warfarin, or Coumadin )
you will be asked to stop taking these ahead
of time. You must let your doctor know
you are taking these medicines.

You should also tell the Interventional
Radiology staff if you are allergic to x-ray
dye, antibiotics, anesthetics, or any other
medicines. Tell them if you have diabetes
and take Glucophage , metformin, or
Glucovance .

The TIPS Placement

You will be taken to an Interventional
Radiology procedure room. A member of
the anesthesiology team will meet you and
talk to you about getting medicine to put you
to sleep for the TIPS. Once you are asleep
the procedure will start (see pages 2 and 3).


After the TIPS and follow-up

You will be taken an intermediate care unit
(IMC) or intensive care unit (ICU). You
will be watched closely overnight. Most
people stay in the hospital 1-2 days.

Within 7-10 days following the TIPS, an
ultrasound will be done to ensure that the
shunt has good blood flow through it. The
TIPS is a little bit like plumbing that may
have some debris buildup in it as the blood
flows through it. If this happens, there is a
greater chance for GI bleeding or ascites to
return.

If the ultrasound shows that some debris has
built up and narrowed the TIPS, a revision
may need to be performed. This is done to
clean out the TIPS. A TIPS revision is done
as an outpatient using conscious sedation.
After giving you a mild sedative, we will
insert a deflated balloon catheter through the
IV in your neck down to the TIPS. Once in
the shunt, the balloon will be inflated to
clean out the TIPS. You will be allowed to
go home the same day with a driver to take
you home.

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You will have ultrasound exams of the TIPS
shunt on a regular basis to ensure the TIPS
remains open. Surveillance ultrasounds and
follow-up care is handled through your
hepatologist.


Things to Remember about Your
TIPS

1. A TIPS shows up on x-rays.
2. It is metal and may trigger electronic
detection devices (i.e., in airports).
3. This type of shunt is allowed in a MRI
(Magnetic Resonance Imaging)
machine.


When to Call the Doctor

 If you have signs of infection at the
puncture site in your neck, such as:
Redness or warmth
Pus-like drainage or bleeding
Excess swelling
Temperature (by mouth) greater
than 100.4oF or 38oC for 2
readings taken four hours apart

 If you have severe pain or spasms in
your belly
 If you feel light-headed or faint

 If you vomit blood or have blood in
your stool

 If you have a large weight gain over
a short period to time (10 pounds in a
week)

 If you notice an increase in your
belly size (within a week)

 If you have new confusion.


Phone Numbers

Interventional Radiology Department, 8:00
to 4:30, Monday - Friday, (608) 263-9729
option #3

After hours, weekends, and holidays, call
(608) 262-2122. This is the paging operator.
Ask for the Interventional Radiology 1st call.
Leave your name and phone number with
the area code. The doctor will call you
back.

Toll Free: 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 ©6/2016, 7/2016 University of Wisconsin
Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#4640.