PTC & PTBDDr Nikrish S Hegde

PTC

• PTC, is a way of examining the bile duct system in the liver.A thin needle is inserted through the skin (percutaneous) and through the liver (transhepatic) into a bile duct. Then dye is injected, and the bile duct system is outlined on x-rays (cholangiography).

PTBD

• A Percutaneous Transhepatic Biliary Drainage is a percutaneous therapeutic procedure which leads to the drainage of the obstructed bile duct system

Indications

• Biliary Stones

• Biliary Strictures

• Malignancy – pancreas,lymph nodes

• Undiagnosed Jaundice

Contraindication

• Sepsis

• Bleeding Disorders

• Contrast Hypersensitivity

Preparation & procedure

• US/CT prior to PTBD, which provides useful information regarding the level of obstruction.

• The doctors will take a blood sample and send this to the laboratory for testing.

• On the day of the examination an intravenous line will be inserted into an arm vein.

• One hour prior to the examination intravenous antibiotics will be given through this line.

• It is not allowed to eat for four hours before the examination, but one may drink clear fluids.

• Patient will be given the opportunity to ask questions about the procedure before signing a consent form.

• The patient will be asked to lie on his/her back on an examination table with the right arm away from the side of your body    (above head).

• Monitoring equipment will be attached; this will measure the blood pressure, heart rate and oxygen saturation.

• The skin will be cleaned with an antiseptic skin preparation lotion.

• Local anaesthetic will be administered into the skin.

• Once the area is numb, the doctor will insert a thin needle through your skin, between the ribs, through the liver, into a bile duct under fluoroscopy guidance . As the needle is withdrawn, a small amount of dye will be injected and x-rays will be taken.

• If the PTC results show a problem, such as a blockage in the bile duct, the doctor may replace the thin needle with a small drainage tube (catheter) .A small pouch may be attached to the end of the catheter outside your body to collect bile.

Complications

• PAIN

• INFECTIONS

• BLEEDING

• The blood pressure and pulse will be monitored.

•   The Haematocrit will be checked.

•   The catheter site will be checked frequently.

•   Patient can eat and drink normally, or as instructed by the Doctors.

•   He/she must be careful not to dislodge the catheter