47536 Exchange of biliary drainage catheter (eg, external, internal-external, or conversion of internal-external to external only), percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, fluoroscopy), and all associated radiolo

Name of the Procedure:

Exchange of Biliary Drainage Catheter
(Common Names: Biliary catheter exchange, Percutaneous biliary drainage)

Summary

The exchange of a biliary drainage catheter is a procedure to replace or change the position of the tube that drains bile from the liver. It often involves using imaging guidance like fluoroscopy to ensure correct placement.

Purpose

This procedure is used to treat obstructions or infections of the bile ducts. It aims to alleviate symptoms such as jaundice, prevent infections, and maintain bile flow.

Indications

• Bile duct obstruction due to tumors or stones
• Bile leakage
• Infections such as cholangitis
• Failure or complications with the existing biliary drainage catheter

Preparation

• Patients may need to fast for several hours before the procedure.
• Certain medications may need to be adjusted or stopped.
• Pre-procedure imaging tests (e.g., ultrasound, MRI) might be necessary.

Procedure Description

1. The patient is positioned appropriately, and local anesthesia is administered.
2. The existing catheter is carefully removed.
3. Contrast dye is injected for a diagnostic cholangiography to map the bile ducts.
4. Imaging guidance (e.g., fluoroscopy) is used to place the new catheter accurately.
5. The new catheter can be positioned as an external, internal-external, or converted depending on the clinical need.
6. The catheter is secured in place, and the site is dressed.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

Usually performed in a hospital’s interventional radiology suite or a similar setting equipped with fluoroscopy.

Personnel

• Interventional Radiologist
• Radiologic Technologist
• Nurses
• Anesthesiologist (if sedation is used)

Risks and Complications

• Infection
• Bleeding
• Bile leakage
• Catheter dislodgment
• Allergic reactions to contrast dye
• Injury to surrounding tissues/organs

Benefits

• Relief from symptoms like jaundice and abdominal pain
• Prevention of infection
• Improved bile flow and liver function
• Preservation of biliary tract integrity

Recovery

• Patients are usually monitored for several hours post-procedure.
• Instructions include how to care for the catheter site and signs of complications.
• Short-term restrictions on activities; follow-up appointments for monitoring and possible further imaging.

Alternatives

• Endoscopic retrograde cholangiopancreatography (ERCP)
• Surgical options for severe cases
• Medications to manage symptoms
• Supportive care (e.g., pain management, dietary changes)

Patient Experience

• Some discomfort during the initial insertion of the catheter.
• Pressure or mild pain when the contrast dye is injected.
• Post-procedure soreness at the insertion site.
• Pain management will be provided to ensure comfort.