Norm of Percutaneous Transhepatic Cholangiography (PTHC, PTC)
Normal diameter and filling of the cystic, hepatic, and common bile ducts. Normal-shaped gallbladder; no masses or irregular borders.
Usage of Percutaneous Transhepatic Cholangiography (PTHC, PTC)
Identification and determination of obstructive jaundice. The procedure may also be completed as part of a work-up for continued pain after cholecystectomy.
Description of Percutaneous Transhepatic Cholangiography (PTHC, PTC)
Fluoroscopic examination of the biliary ducts using an iodine-based contrast dye; the test is performed in the radiology department by a radiologist, and the client is given IV sedation or a local anesthetic. This allows visualization of all the bile ducts and biliary flow. These ducts will appear dilated if there is an obstruction. Biliary obstruction causes that can be identified may be filling defects, spasms of the sphincter of Oddi, strictures, tumors, and stones, particularly those located in the common bile duct. This test may be performed in conjunction with magnetic resonance imaging or computed tomography.
Professional Considerations of Percutaneous Transhepatic Cholangiography (PTHC, PTC)
Consent form IS required.
Allergic reaction to dye (itching, hives, rash, tight feeling in the throat, shortness of breath, bronchospasm, anaphylaxis, death), bleeding, extravasation of contrast dye into the peritoneal cavity, peritonitis, renal toxicity from contrast medium, septicemia, and subcapsular injection.
Previous allergy to iodine, shellfish, or radiographic dye; massive ascites or uncontrolled coagulopathies; pregnancy (because of radioactive iodine crossing the blood-placental barrier); renal insufficiency; sedatives are contraindicated in clients with central nervous system depression.
Client may be premedicated with diphenhydramine to prevent reaction.
- See Client and Family Teaching.
- Notify the physician and the radiologist of any known or possible allergy to determine if premedication will be prescribed.
- Obtain baseline prothrombin time, clotting time, and platelet counts. Notify the physician and the radiologist of any abnormalities. Transfusion to normalize coagulation may be prescribed just before the study.
- A sedative may be prescribed, especially for children. Monitor the respiratory status continually if sedation is given.
- Perform a surgical scrub and obtain povidone-iodine solution, 2% lidocaine (Xylocaine), a 23-gauge flexible needle, sterile gloves and drapes, and contrast medium.
- Have emergency equipment readily available.
- When this procedure uses the small, flexible needle, surgical backup is no longer considered necessary. If a large-bore needle is used, this procedure should have surgical backup.
- Just before beginning the procedure, take a “time out” to verify the correct client, procedure, and site.
- The client is secured in a supine position on the fluoroscopy tilt table.
- The upper right quadrant of the abdomen is cleansed with surgical scrub solution and prepared with povidone-iodine solution. The entire abdomen is covered with sterile drapes.
- The skin is anesthetized with 2% lidocaine.
- By means of a long, flexible, 23-gauge needle, the liver is punctured, and the needle is advanced under fluoroscopy until bile is aspirated from the duct. A small amount of contrast dye is injected, and placement is visualized by fluoroscopy. Once the needle is located in the biliary tract, the remaining contrast dye is injected. If the bile ducts appear dilated, the contrast material will be diluted to allow for full visualization of the biliary tract without additional contrast-medium dose.
- Fluoroscopy is used to observe the flow of contrast medium through the ducts into the small intestine. It may be necessary to gently rotate the scanning table vertically and horizontally, or the client may be asked to change to a side-lying position. Erect or decubitus films may be required to visualize the complete system.
- Apply a dry, sterile dressing to the injection site.
- Assess the injection site for bleeding, swelling, or tenderness every hour × 4 and then every 8 hours until 24 hours after the procedure.
- Continue post sedation assessment of the respiratory status. If deep sedation was used, follow institutional protocol for post sedation monitoring. Typical monitoring includes continuous ECG monitoring and pulse oximetry, with continual assessments (every 5–15 minutes) of airway, vital signs, and neurologic status until the client is lying quietly awake, is breathing independently, and responds to commands spoken in a normal tone.
- Maintain bed rest for several hours as prescribed. A right side-lying position may be prescribed.
- Resume previous diet.
- Analgesics may be prescribed for pain.
- Observe for signs of septicemia, peritonitis, hemorrhage, and tension pneumothorax.
- Antibiotics may be continued for 2–3 days.
Client and Family Teaching
- Fast from food and fluids for 8–12 hours before the procedure.
- A mild laxative such as magnesium citrate may be prescribed the night before the procedure.
- Antibiotics may be prescribed during the 24–48 hours before the procedure.
- Transient pain may be experienced during the injection of the dye.
- It is important to lie still for the study to avoid injury to internal organs. Sedation may be used to help you lie still.
- There should be a responsible adult available to take you home and care for you for 24 hours.
- Surgical intervention may be required if obstruction is diagnosed.
- The procedure takes up to 1 hour.
Factors That Affect Results
- Gas overlying the biliary ducts or obesity can interfere with radiograph clarity.
- Barium, from previous studies, may interfere with the fluoroscopy.