"Provided all has gone well, other than routine cardiovascular observations, no specific post-procedural care is required."
"Percutaneous biliary interventions are associated with a complication rate that sit between approximately 3-10% 5 . Complications include but are not limited to:"
"Purely diagnostic percutaneous transhepatic cholangiography is performed when other less invasive methods of imaging the biliary tree (e.g. MRCP, ERCP, CT IVC) have proven unsatisfactory. Indications include:"
"failed ERCP / ERCP not feasible (e.g. patients with gastrojejunostomy)"
"failed ERCP / ERCP not feasible (e.g. patients with gastrojejunostomy)"
"anatomic evaluation of complications of ERCP"
"Before beginning the procedure one must evaluate all the available imaging data of the patient and understand the correct indication for this invasive procedure. Routine investigations that need to be looked at are liver function tests, baseline blood investigations like full blood count, coagulation profile (prothrombin time, PTT, INR, and platelet count); if any of these tests are abnormal corrective measures should be taken before the procedure."
"Once a satisfactory position of the needle is confirmed, an adequate amount of contrast material is injected. Care should be taken to avoid potential displacement of the needle 5. A number of projections of the biliary tree are obtained to evaluate the obstructive pathology (including PA, RAO and LAO)."
"Once a satisfactory position of the needle is confirmed, an adequate amount of contrast material is injected. Care should be taken to avoid potential displacement of the needle 5. A number of projections of the biliary tree are obtained to evaluate the obstructive pathology (including PA, RAO and LAO)."
"Chiba needle (22G, 15 cm long)"
Expected headings
"Preprocedural evaluation"
"Positioning/room set up"
"Percutaneous transhepatic cholangiography (PTC) is a radiographic technique employed in the visualisation of the biliary tree and can be used as the first step in a number of percutaneous biliary interventions (e.g. percutaneous transhepatic biliary stent placement)."
"failed ERCP / ERCP not feasible (e.g. patients with gastrojejunostomy)"
"Before beginning the procedure one must evaluate all the available imaging data of the patient and understand the correct indication for this invasive procedure. Routine investigations that need to be looked at are liver function tests, baseline blood investigations like full blood count, coagulation profile (prothrombin time, PTT, INR, and platelet count); if any of these tests are abnormal corrective measures should be taken before the procedure."
"The needle entry point is usually planned by using ultrasound guidance (increasingly used worldwide). A direct fluoroscopic approach was described initially and is still commonly used. A long two-part needle (approximately 15 cm) 22 G is inserted under ultrasound guidance into one of the peripheral ducts; after removing the needle stylet one can observe bile reflux at the needle hub or inject a small amount of contrast to confirm duct puncture on fluoroscopy. The needle when inserted should pass superior to the upper border of a rib to avoid injury to neurovascular bundles 5."
"Once a satisfactory position of the needle is confirmed, an adequate amount of contrast material is injected. Care should be taken to avoid potential displacement of the needle 5. A number of projections of the biliary tree are obtained to evaluate the obstructive pathology (including PA, RAO and LAO)."