Both ultrasound and computed tomography (CT) can be used to guide to percutaneous needle intervention. The choice of methods depends on multiple factors including lesion size, locations, equipment availability etc.
Ultrasound has several strengths as guiding percutaneous interventions. It is readily available, relatively inexpensive, and portable. It has no ionizing effects and can be used in almost all anatomical plane. The greatest advantage, however, is that it allows real-time visualization of needle tip as it passes through the tissue into the target. Ultrasound provides precise needle guidance to allow for needle aspiration
or catheter drainage of superficial and deep fluid collections throughout the body.
First, introduced in 1921 with direct puncture of the gallbladder. The technique was revolutionized in the 1960s with the introduction of fine-gauge (22- to 23-gauge) needles. It is an interventional radiology procedure undertaken for those with biliary obstruction. Biliary drainage relieves obstruction by providing an alternative pathway to exit the liver. If the bile duct becomes blocked, the bile cannot drain normally and backs up in the liver.
- Biliary stones – within the gallbladder or within the bile ducts
- sclerosing cholangitis
- Tumors of the pancreas, gallbladder, bile duct, liver
- Biliary Strictures
- Malignancy: eg pancreas, Lymph nodes
- Undiagnosed jaundice
- Injury to the bile ducts during surgery
- bleeding disorders
- contrast hypersensitivity
-The procedure and risk should be explained to the patient.
-The patient needs to empty stomach at least 4 hours.
-Patient need to get IV antibiotic before the procedures start
-We routinely require platelets and PT for the drainage procedure
-IV access is obtained to the patients for administration of medications and emergency access for complications
Technique and stenting
-The patient will lie on supine position
-Educate the patients about the whole procedure
-Skin will be cleaned with an antiseptic solution, and most of the rest of your body will be covered with a sterile towel
-The radiologist will use an ultrasound machine to decide on the most suitable point for inserting the fine plastic tube (the drainage catheter)
-Normally inserted between two of your lower ribs, on the right side
-Apply local anesthesia lidocaine 1% solution. The usual maximum adult dose for local anesthesia is 4.5 mg/Kg
-A small incision was made.
– Catheter insertion can be performed using the Seldinger technique; the choice usually depends on operator preference.
-When the radiologist is sure that the needle is in a satisfactory position in one of the bile ducts, a guide wire will be placed through the needle into the bile duct; this enables the plastic drainage catheter to be positioned correctly. The procedure may end at this stage, with the catheter being fixed to the skin surface, and attached to a drainage bag.
-Repeat ultrasound is done to look for drainage site and any complications.
-In some cases, a permanent metal tube, called a stent, may be placed across the obstruction to relieve the blockage. Even if this is done, a temporary external catheter may be left in place, attached to a drainage bag.
Percutaneous biliary drainage is considered a very safe procedure, designed to save you having a larger operation. Sometimes the bile may leak around the catheter and form a collection in the abdomen that can cause pain and may require drainage.
It usually takes 30 to 40 minute.
-The patient will send to ward
-Monitor vitals 8 hourly
-Take care of drainage bag so that catheter doesn’t get pulled out.
-All drains must be irrigated regularly. Injection and aspiration of 10 mL of isotonic sterile saline three or four times daily is usually sufficient
-Empty the drainage bag 8 hourly and record the output.
-If the patient goes home, educate the patient about catheter care and drainage output
Catheter Removal: Three criteria for catheter removal are as follow:
1. Negligible drainage over 24 hours
2. Afebrile patient
3. Minimal residual cavity
The catheter should be removed gradually over a few days, which promotes healing by secondary intentions.
Advantages of biliary drainage:
If a patient is suffering from symptoms of a blocked bile duct, such as skin discoloration, itching, rashes, nausea and tiredness, a biliary drainage may relieve some of these symptoms over time (it often takes a number of days after the procedure for these benefits to become apparent). If the bile in the blocked bile ducts is infected, biliary drainage is an important part of the treatment. Hepatic functions may be improved after biliary drainage.