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. 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. 2. It can be used to make some patients with long-term blockage more comfortable. 1
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. 2
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. 3
(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. 4
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. Mild soap( ie: Dove) sterile 2x2 gauze dressings medium size Tegaderm Clear adhesive tape or paper tape (if sensitive to Tegaderm ) Drainage bags (only if needed otherwise change every 2-4 weeks) Extension tubing (CTU-14 change only if needed otherwise change every 2-4 weeks) 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: increased tenderness or pain increased redness or swelling 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. Gently wash the skin around the exit site. Rinse site with wet washcloth Wipe dry 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 5
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 F (38 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 6