"haemorrhage: often the haemorrhage occurs into a hepatic vein; if the bleeding is arterial it requires angiography/embolisation."
"guidewires (.035'') and stiff floppy tip glide wire"
"Under ultrasound guidance the internal jugular vein on the right side is punctured. A .035" guide wire inserted into the superior vena cava and a 9 F sheath is placed over the wire after adequate dilatation. Venous puncture can be done with a micropuncture set 21-22 G in children and in patients with deranged coagulation parameters. A puncture too low carries a risk of a pneumothorax. Inadvertent carotid punctures should be avoided. Connecting the needle to a syringe containing saline helps identify venous entry. Then a combination of guidewire and a catheter is used to gain entry into the right hepatic vein (multi purpose/ head hunter catheter with .035" wire serves this purpose). The superior vena cava and the right atrium needs to be negotiated with the wire and catheter. Too much coiling of wire in the right atrium may give rise to arrhythmia hence continuous monitoring of pulse, ECG rhythm is mandatory during the procedure. Usually, the IVC can be traversed by asking the patient to be in deep inspiration. After gaining access to the right hepatic vein, a venogram is obtained to confirm the right hepatic vein position."
"Under ultrasound guidance the internal jugular vein on the right side is punctured. A .035" guide wire inserted into the superior vena cava and a 9 F sheath is placed over the wire after adequate dilatation. Venous puncture can be done with a micropuncture set 21-22 G in children and in patients with deranged coagulation parameters. A puncture too low carries a risk of a pneumothorax. Inadvertent carotid punctures should be avoided. Connecting the needle to a syringe containing saline helps identify venous entry. Then a combination of guidewire and a catheter is used to gain entry into the right hepatic vein (multi purpose/ head hunter catheter with .035" wire serves this purpose). The superior vena cava and the right atrium needs to be negotiated with the wire and catheter. Too much coiling of wire in the right atrium may give rise to arrhythmia hence continuous monitoring of pulse, ECG rhythm is mandatory during the procedure. Usually, the IVC can be traversed by asking the patient to be in deep inspiration. After gaining access to the right hepatic vein, a venogram is obtained to confirm the right hepatic vein position."
"The catheter is then exchanged with 7 F TJLB sheath gently over a stiff wire. Once the tip of the sheath is in the mid RHV, trucut TJLB needle is inserted and 2-3 cores of liver tissue obtained after entering the liver parenchyma through the hepatic vein (this is done by anterior rotation of the TJLB sheath before obtaining biopsy specimen)."
Expected headings
"Equipment required"
"Patient positioning"
"Transjugular liver biopsy (TJLB) is an alternative to a percutaneous liver biopsy in patients with diffuse liver disease, coagulopathy and ascites."
"There are no real contraindications for a transjugular liver biopsy."
"haemorrhage: often the haemorrhage occurs into a hepatic vein; if the bleeding is arterial it requires angiography/embolisation."
"liver capsular rupture +/- haemoperitoneum: close monitoring is required post procedure (sufficient liver parenchyma has to be ensured anterior to the right hepatic vein; if not, then left lobe or middle hepatic vein to be selected)"
"History and etymology"