Per Cutaneous Trans Hepatic Cholangiogram (PTC)

8/4/2019 Per Cutaneous Trans Hepatic Cholangiogram (PTC)

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Percutaneous Transhepatic

Cholangiogram PTC

A procedure to x-ray the hepatic and common

bile ducts.

This procedure is done under local anaesthesia by

a radiologist.

During the exam, a thin needle is inserted

through the skin (percutaneous) and through the

liver (transhepatic) into a bile duct. Then contrastmedia is injected, and the bile duct system is

outlined - imaging is performed fluoroscopy


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Indications for imaging

Jaundice may be caused by

obstruction, infection, scarring, stones, or a

carcinoma in the bile ducts, liver, pancreas.

a leak in a bile duct may allow bile to flow into

the abdominal cavity. PTC allows visualisation

of the ducts to see if they are partially or

completely blocked


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If necessary, a thin, flexible tube (catheter)

may be inserted to allow the bile to drain into

a collection bag outside the body, or into the

small intestine.

This procedure is called biliary drainage.

Drainage catheters may be placed to divert

bile. Stones can be removed,


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Contraindications

Patients at increased risk of bleeding

Biliary tract sepsis Hydatid disease


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Equipment

General fluoroscopic with spot film device

Sterile towels

Local anaesthetic equipment Chiba needle - flexible 22 gauge 18 cm long


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Contrast agents Low osmolar 200 mg/ml 20 - 60 ml.

Patient Preparation

Haemoglobin, prothrombin time and platelets are need to

be checked before the procedure takes place. antibiotic cover typically ampicillin 500 mg. 24 hours

before procedure and for 3 days after

nil by mouth for 4 hours before procedure


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Technique

The patient lies supine and the area of needle

insertion, deep tissue and liver capsule are

anesthetized - and time given for it to act.

Under fluoroscopic control the Cheba needle is

introduced into the liver in suspended respiration,

when correctly positioned the patient is permitted to

breath gently.


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a syringe containing contrast media attached,

contrast media is injected under fluoroscopic

control as the needle is slowly withdrawn until a

duct is demonstrated, this may require severalmanipulations of the needle up to 10 times.

A biliary sample is withdrawn for analysis and

then contrast media is injected to fill the ductalsystem and identify the level of obstruction


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Films

Control film right upper quadrant before

procedure

Supine, 45degree RPO, Rt Lateral,

Trendelenberg

Erect, 45degree RPO, Rt Lateral


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Biliary Drainage Catheter Placement if requiredFollowing the initial injection of contrast (x-ray dye)into the bile duct during a PTC, the interventionalradiologist next guides a small guide wire throughthe needle, into the ducts and across the site ofblockage while watching the wire and ducts on x-ray.Over this wire, a small tube (catheter) is theninserted to allow the bile to be drained from the

liver, relieving the jaundice caused by blockage of theduct.


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AftercarePulse and blood pressure half hourly for 6 hoursCheck puncture site for bleeding at the same time.

Complications

Mortality less than 1% Allergic reactions are rare Cholangitis, haemorrhage,

Subphrenic abscess, and septicaemia.


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PTC demonstrating dilated ducts


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Image of the bile ducts, following the injection of x-ray dye, showing a large

gallstone trapped in the duct


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The same duct, following removal

of the stone through the

drainage catheter

Per Cutaneous Trans Hepatic Cholangiogram (PTC)

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