Norm of Postoperative T-Tube Cholangiography
Even filling of the biliary ductal system. Absence of strictures, obstruction, calculi, abnormal pathways, or delays in emptying.
Usage of Postoperative T-Tube Cholangiography
Evaluation of biliary ducts for calculi, leakage, stricture, and instrumentation injuries after gallbladder surgery or liver transplantation.
Description of Postoperative T-Tube Cholangiography
T-tube cholangiography is the instillation of radiographic contrast medium through a T-tube (percutaneously inserted, T-shaped, bile duct drainage tube), followed by fluoroscopic examination of the biliary ducts. Use of intraoperative cholangiography minimizes the number of biliary calculi remaining after surgery, but up to 3% of surgeries miss some calculi, and bile duct damage, resulting in strictures, can result. Because of this possibility, T-tube cholangiography is usually performed 7–10 days after exploratory gallbladder or duct surgery or cholecystectomy for the purpose of evaluating duct patency and identifying any remaining stones or further ductal obstruction. Biliary duct obstruction or anastomotic leakage is also possible after liver transplantation; thus a T-tube is also placed after this type of surgery. If retained stones are identified, the T-tube is left in place because this is the route of choice for removal of the remaining stones. A total 4–6 weeks are required for the sinus tract surrounding the T-tube to be well healed before percutaneous removal of remaining stones.
Professional Considerations of Postoperative T-Tube Cholangiography
Consent form IS required.
Allergic reaction to dye (itching, hives, rash, tight feeling in the throat, shortness of breath, anaphylaxis, death); renal toxicity from contrast medium.
Previous allergy to iodine, shellfish, or radiographic dye; pregnancy (because of the radioactive iodine crossing the blood-placental barrier); renal insufficiency.
- A cleansing enema may be prescribed.
- Have emergency equipment readily available.
- The T-tube may be clamped for 24 hours before the procedure.
- See Client and Family Teaching.
- Just before beginning the procedure, take a “time out” to verify the correct client, procedure, and site.
- The client is positioned supine.
- Local anesthetic may be injected around the T-tube site if the site is inflamed and painful.
- After the T-tube is cleansed with 70% alcohol, radiographic contrast medium is instilled through the tube via a large-caliber catheter.
- Fluoroscopic radiographs are taken in a variety of positions to track dye progress through the biliary duct system. Upright films are taken to detect inadvertent injection of air through the T-tube.
- The procedure is concluded with films of contrast medium emptying into the duodenum. Delays in emptying prolong the procedure, which normally takes less than ½ hour.
- If findings are normal, the T-tube is removed, and a dry, sterile dressing is applied to the site.
- If the T-tube has been removed, assess the site for redness, edema, pain, or drainage every hour × 4 and then every 4 hours until 24 hours after removal. A T-tube left in place should be reconnected to drainage.
- Assess for allergic reaction to the dye (listed above) for 24 hours.
- Resume previous diet.
Client and Family Teaching
- Fast from food and fluids for 6 hours before the procedure.
Factors That Affect Results
- Inadvertent injection of air may cause bubbles that look like biliary calculi. One may differentiate these by observing for movement when the client is positioned upright. Calculi move down with gravity, whereas air bubbles rise.
- This procedure uses a low-dilution or high-dilution iodine contrast medium. A low-dilution medium requires longer x-ray exposure than a high-dilution medium.
- The preoperative administration of morphine sulfate 0.05 mg/kg intravenously may result in spasm of the ampulla of Vater and duodenum, resulting in improved quality of cholangiography.
- Routine antibiotic prophylaxis after the procedure has not been found to be necessary for most clients.
- See also Magnetic resonance cholangiopancreatography.