Name of the Procedure:

Placement of biliary drainage catheter, percutaneous (external)

• Common Name: External biliary drainage
• Medical Terms: Percutaneous biliary catheterization, Percutaneous transhepatic biliary drainage (PTBD)

Summary

This procedure involves the insertion of a thin tube through the skin into the liver to drain bile. It's guided by imaging techniques such as ultrasound or fluoroscopy and includes diagnostic cholangiography if needed.

Purpose

External biliary drainage addresses blockages in the bile ducts that prevent bile from flowing from the liver to the gallbladder and small intestine. The procedure aims to relieve symptoms such as jaundice and prevent complications related to bile duct obstructions.

Indications

• Jaundice caused by bile duct obstruction
• Cholangitis (infection of the bile ducts)
• Biliary strictures or tumors
• Inoperable pancreatic cancer causing bile duct obstruction

Preparation

• Patients may be instructed to fast for several hours before the procedure.
• Blood tests to check clotting status and liver function.
• Imaging studies like an ultrasound or CT scan to plan the procedure.

Procedure Description

1. The patient lies on their back or side.
2. Local anesthesia is applied to numb the area.
3. A small incision is made in the skin.
4. Using ultrasound or fluoroscopy for guidance, the radiologist inserts a needle into the bile ducts.
5. Contrast dye may be injected for cholangiography to visualize the bile ducts.
6. A guide wire is passed through the needle, and a drainage catheter is advanced over the wire.
7. The catheter is secured in place, external drainage is ensured.

Duration

The procedure typically takes 1-2 hours.

Setting

This procedure is usually performed in a hospital's radiology or interventional suite equipped with fluoroscopy and ultrasound.

Personnel

• Interventional Radiologist
• Radiology Technologist
• Nurses
• Anesthesiologist or a nurse providing sedation (if necessary)

Risks and Complications

• Infection
• Bleeding
• Injury to liver or bile ducts
• Leakage of bile
• Pain at the catheter site
• Catheter displacement or blockage

Benefits

• Immediate relief from symptoms of bile duct obstruction.
• Improves liver function by restoring bile flow.
• Reduces risk of infection and other complications related to bile duct blockage.

Recovery

• Patients may need to stay in the hospital for observation.
• Instructions include keeping the catheter site clean and dry.
• Restrictions on physical activity to prevent catheter displacement.
• Follow-up appointments for catheter management or replacement.

Alternatives

• Endoscopic Retrograde Cholangiopancreatography (ERCP): Less invasive but not always possible due to anatomical difficulties.
• Surgery: More invasive with a longer recovery period.

Patient Experience

• Local anesthesia minimizes pain during the procedure, but some discomfort from needle insertion is possible.
• Mild pain or soreness at the insertion site post-procedure.
• Instructions on managing the catheter and recognizing signs of complications will be provided.
• Pain management includes over-the-counter pain relievers or prescription medication if necessary.