What You Need to Know about Your PTCD UHN Information for patients and families Read this information to learn: what a PTCD is how to prepare what to expect how to care for your PTCD what problems to look out for who to call if you have any questions Please visit the UHN Patient Education website for more health information: www.uhnpatienteducation.ca 2015 University Health Network. All rights reserved. This information is to be used for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis or treatment. Please consult your health care provider for advice about a specific medical condition. A single copy of these materials may be reprinted for non-commercial personal use only. Author: Pauline Lambert; Revised by Irene Ravadilla-Semella Revised: 06/2015 Form: D-5351
What is a PTCD? PTCD is short for percutaneous transhepatic cholangio drain. It is a tube put into a blocked bile duct to open it up and drain it. A trained radiologist uses the help of a special kind of x-ray to guide the PTCD tube to the right place. How do I prepare for a PTCD? Get your blood tests done at least 1 week before the procedure. Take the form that the doctor who scheduled you for this procedure gave you to the Central Lab. There are central labs on the Ground floors of Toronto General Hospital (TGH) and Toronto Western Hospital (TWH). You don t need an appointment. If you do not get these blood tests, the hospital may have to cancel your procedure. Some medicines may increase your risk of bleeding during or after your procedure. Tell your doctor or health care provider if you are taking: medicines such as acetylsalicylic acid (Aspirin ), clopidogrel (Plavix ), prasugrel (Effient ), ticagrelor (Brillinta ), ibuprofen (Advil, Motrin, Nuprin ), naproxen (Naprosyn ) or indomethacin medicines such as warfarin (Coumadin ), dalteparin (Fragmin ), enoxaparin (Lovenox ), tinzaparin (Innohep ), fondaparinux (Arixtra ), dabigatran (Pradaxa ), rivaroxaban (Xarelto ) or apixaban (Eliquis ) Your doctor or health care provider may tell you to stop taking these medicines for a certain number of days before your procedure. Don t eat or drink anything after midnight (12:00 am) before your procedure. ; ; Don t take any medicines the day of your procedure unless your doctor who scheduled you for this procedure gave you different instructions. 2
What should I bring? You will need to stay in the hospital for a few days after you get your PTCD so we can check how you are doing. Bring all of your medicines in their original bottles with you as well as a list of these medicines. This includes over-the-counter medicines like cold medicine, herbal supplements and vitamins. We will give you any medicine you need from your own supply once you are at the hospital. Bring any special equipment you may need and put your name on them. This may include oxygen, puffers, or tube feeding supplies. Bring your health card (OHIP). When should I come to the hospital? Come to the Medical Imaging Reception Desk 1 hour before your procedure starts. For example, if your procedure is at 9:00 am, come to the hospital by 8:00 am. We need this extra time to get you ready for your procedure. The Medical Imaging reception desk is on the 1 st floor next to Tim Horton s at TGH and on the 3 rd floor, East Wing at TWH. What can I expect? Before the procedure 1. At the reception desk, we ask to see your health card to check you in. 2. We tell you how to go to the Medical Imaging Day Unit (MIDU). When you get there, a nurse meets with you. 3. The nurse asks you to remove your clothing and put on a hospital gown. The nurse also asks you questions about your health. 4. You lie on a stretcher, and the nurse starts an Intravenous (IV) line. 3
5. The radiologist talks to you about the procedure and asks you to sign a consent form (a form that says you agree to have the procedure). 6. While you are on the stretcher, we move you into the procedure room. Remember: We try our best to be on time. Please be patient if there is a delay. Only 1 person can stay in the MIDU with you after your procedure. Please plan ahead for a babysitter if you have young children. No picture taking is allowed in the MIDU. During the procedure 1. We move you onto the procedure table. A radiologist, nurse and Medical Radiation Technologist (MRT) are in the room with you. 2. We do an ultrasound to make sure we know the correct area to put in the needle used to give you the PTCD. 3. We give you medicines for pain and to help you relax. 4. The radiologist uses a very small needle to inject the right side of your abdomen with a local anesthetic. This is a medicine that will freeze or numb that area of your body. 5. Once the area is numbed, the radiologist uses a fluoroscopy (a special kind of x-ray) to see your bile duct better. They put a needle into your abdomen and into your liver, followed by a wire. They use this wire to break up the stones that block your bile duct. 6. The radiologist puts a PTCD tube over the needle and then removes the needle and wire. The tube is left in your bile duct. A small part of the tube comes through your skin to the outside of your body. 7. If the tube is capped, bile drains into your intestines. If the tube is left open, bile drains into a bag that is attached to the end of the tube outside of your body. 4
After the procedure We take you back to the MIDU to recover. When you wake up from the medicines we gave you to help you relax and help with the pain, we take you to an Inpatient Unit. You stay there for a few days. How do I care for my PTCD? The PTCD is in a place that makes it hard for you to care for it yourself. You will need help. We will contact the local Community Care Access Centre (CCAC). CCAC may refer you to a local clinic to help you with the dressing changes. We will teach you and a family member how to care for the tube so you can be independent. What do I need to know about the dressing on my PTCD? At first, the PTCD may be stitched to your skin to make sure it stays in place. To keep the tube in place for a longer time, we usually keep the tube firmly against your skin using a stable tube dressing. We will give you another brochure called How to Change Your Drainage Tube Dressing, to show you how to do stable tube dressing. We use dry gauze to cover the cut in your skin where your PTCD tube goes in. This is the only part of the dressing that you or your helper should change. If the clear dressing from your stable dressing comes loose, tape it down until a nurse can change the whole dressing. Do not remove this clear dressing. Your tube could fall out. 5
Remember: Keep the bag attached to your tube securely in place. To protect your tube, pin the bag to your clothes using safety pins or use the leg straps to keep it in place. There should be no pulling or stretching on the tube connected to the bag. Make sure to empty the bag often. Make sure you empty the bag when it is almost half full. Keep the skin around your tube dry. Clean the skin around your tube every day using soap and water. You can cover the tube with sterile (germ-free) gauze if you like. ; ; Make an appointment to have your tube changed every 3 or 4 months or when problems happen. 6
What problems should I look out for? This chart has information about what problems may happen, how to prevent them, and what to do if they happen. Problem How to prevent it How to treat it Skin infection Redness, soreness or swelling of the skin where the tube goes in. Clean the tube and the skin where the tube was put in every day with normal saline (you can buy it at your pharmacy). Check for redness, soreness or swelling in this area every day. Keep the skin around your tube dry. Change your dressing twice every day (more if needed). Clean your tube and skin with normal saline. Put an antibiotic ointment (for example Polysporin ) on your skin where the PTCD goes in every time you change your dressing. Then, put dry, sterile gauze over the tube. If it does not get better after 2 days, tell the doctor who ordered this tube for you. Pain In the beginning, you may have pain because the tube is irritating your skin. Over time, this pain will decrease and go away. It is hard to prevent this kind of pain. You can take acetaminophen (Tylenol ) for pain if you need it. If your pain gets worse, call the clinical nurse coordinator (see page 10) to make an appointment. We will check to make sure your tube is working correctly and that there are no problems. If the pain continues and the tube is not the problem, make an appointment with your doctor. 7
Problem How to prevent it How to treat it The tube has moved Your tube looks like it has partly come out or is completely out. Make sure your bag is firmly in place. Use safety pins or leg straps to secure the tube. Don t pull off the see-through dressing without help. Check your dressing every day to make sure it is securely in place. There should be no pulling or stretching on the tube connected to the bag. Empty the bag often. If your tube is partly out, tape it in place. It is important to keep it in as much as possible because your new tube can go in through the same opening. Call the Medical Imaging booking department (see page 10) to make an appointment that same day. Don t wait, because the opening and path to your duct can close quickly. If it does, it will be difficult to replace the tube. After regular hours or on weekends, go to TGH or TWH emergency department or the nearest emergency department to you. 8
Problem How to prevent it How to treat it Fever and chills If you have fever and chills, you may have an infection. Rinse your bag out with water everyday. Keep your appointments to change your tube every 3 or 4 months. If your tube is capped, uncap it and connect it to a drainage bag. If bile drains well, your fever and chills will probably go away. Call the Medical Imaging booking department (see page 10) to make an appointment to have your tube changed in the next 2 or 3 days. After regular hours or on weekends, go to TGH or TWH emergency department or the nearest emergency department to you. Bile leaking from around your tube If there is enough to soak your gauze, it usually means that your tube is blocked. Look to see if you have any kinks in the tubing. If you do, straighten them out. If you don t, it means it is blocked on the inside. This kind of block is hard to prevent. If your tube is capped, uncap it and attach it to a drainage bag. This lets bile drain out. Call the Medical Imaging booking department (see page 10) to make an appointment for a tube change on the next day. 9
Who do I call if I have any questions? Call your doctor who referred you for a PTCD if you have any other questions about the drain or anything about your care. Call the clinical nurse coordinator if you have any problems with your PTCD: Toronto General Hospital Phone: 416 340 4800 extension 5403 Toronto Western Hospital Phone: 416 603 5800 extension 6301 To schedule an appointment: Call the Medical Imaging booking department to book an appointment. Phone: 416 340 3384 Hours: Monday to Friday, 8:00 am to 4:00 pm Go to the emergency department at Toronto General or Toronto Western Hospital or your nearest emergency department if a problem with your tube happens after hours, on weekends or on holidays. 10