cutaneous Transhepatic Ceeesetarerreysresry tana Oo Percutaneous Transhepatic _Cholangiography (PTC) _ PTC -itis a radiographic imaging technique in which percutaneous injection of radio-opaque contrast media is directly injected into the bile duct to visualize the abnormalities in the biliary system. In this procedure, a thin needle is inserted through the skin into the liver to reach the bile duct. The test is performed in the radiology department by surgeons, radiologist, anesthetics and other Healthcare teams. Indication- e Biliary obstruction due to gallstone or mass e Strictures in the bile duct e The unknown reason for Jaundice e ERCP study become failed or facility not available e ERCP not possible due to abnormalities in the esophagus or small intestine Contraindication- e Hypersensitivity to lodine Ascites (abnormal accumulation fluid in the abdominal) e Blood clotting disorder e Suspected pregnancy e Large liver tumors e Severe infection at the Puncture site« Fluoroscopic unit with spot film device or image recorder device « Ultra-Sonography machine e Needle Chiba 22G e Contrast media Water soluble non-ionic e Antiseptic solution ¢ Local anesthesia e Syringe e Gloves e Sterile towel e Gauze 1 Pre-procedure investigations- they are necessary prior to the examination that are- Liver function test blood repor Blood Urea ,Serum creatinine, Ultrasonography reports and CT and MRI reports, ts, Total blood count, Bleeding and clotting time, atient preparation- The patient should not eat or drink after midnight. Patients USG reports, CT and MRI report, liver function test, blood clotting reports must be reviewed by radiologist prior to the examination. » Patient kidney function urea serum creatinine must be reviewed before the examination « Ask the patient to stop taking anticoagulant before the exam. 7 On the day of the examination- « Describe the whole procedure to the patient. « Technologist should obtain consent from the patient for permission of procedure. e Ask the patient to remove clothing and wear a Hospital gown. e An intravenous line is inserted into the patient arm and sedative medication is given through line to make patient relax.TEC Mnenelo eet Procedure- 1, Place the patient in supine position on the X-ray fluoroscopic table 2. The patient right arm is placed above the head for cleaning the patient right rib area with antiseptics. Antibiotics and medications are given to the patient through IV line prior to the procedure. he pati 7 ‘ The patient Blood Pressure, heart rate, oxygen level, and other vital sign should be monitored regularly The right ae eg of the patient must be cleaned with the antiseptic solution under strict sterile protocol and draped with a sterile towel. Then the interventional radiologist identifies minimal invasive distance to access under ultra sonography guidance 6. The Local anesthesia is given at the insertion site that is the Midaxillary line between intercostal spaces at caudal part of the lung. After numbing the area the Radiologist inserts the Chiba needle percutaneously through the skin, between the intercostal space of ribs, under the Ultrasonography guidance. Then he gently push the needle through the liver into the bile duct. x 8. During the insertion of a needle, instruct the patient to hold respiration in the expiration ph, e Once the needle tip enters in bile duct the entire procedure will be done in fluoroscopy guidance. After insertion of needle successfully contrast media is injected and radivg:aphis are taken or recorde ther spot film device or by image recorder. 9 The radiologist may evaluate the patency and the abnormalities of the biliary system. 10. If the radiologist found any abnormalities or blockage in the duct ,the surgeons may advance a catheter over the needle. This catheter is called bile drainage tube for therapeutic and di gnostic aid 1. After completion of the procedure re nove the Chiba needle and applied dressing on the puncture site.possibility of gallbladder perforation Infection and bleeding on puncture site Peritonitis 1 Aftercare- Keep the patient in the observation room. The patient blood pressure, heart rate oxygen level, and other vital sign should be monitored regularly. Fig: Percutaneous Transhepatic Cholangiography