This information leaflet has been produced to give you general information and hopes to answer most of your questions about a Percutaneous Trans hepatic Cholangiogram (PTC). It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading it you have concerns or require further explanation, please discuss this with a member of the healthcare team.
Why do I need this procedure?
This investigation may be needed for a number of different reasons such as:
- You may require bile draining to deal with infection or to reduce jaundice.
- You may require investigations into why you have developed jaundice.
- You may have a narrowing of the bile duct due to cancers, previous surgery, gallstones or other health related problems which require treatment or stenting.
A PTC is a procedure in which a small plastic tube (drain) is inserted into the bile ducts within the liver through the skin to drain the bile. It is can be combined with putting a stent in the bile ducts to enable the bile to drain more freely. By helping the bile to drain more freely you should get relief from any pain or discomfort you are experiencing, it can help to reduce jaundice and relieve symptoms.
PTC is typically performed because you have become jaundiced (yellow) and extremely itchy. This is because the bile cannot flow normally into the gut and the condition makes you susceptible to infection. The most common reasons for this are gallstones and pancreatic masses, although there are other causes.
The PTC is often performed in a number of stages. The plastic tube (drain) is normally placed into the bile ducts during the first part. Stents are usually inserted a few days after the initial drainage procedure and they keep the narrowed duct open. A new drain in left in place for another day until the doctor is certain that the stent is draining the bile adequately. The drain is removed once this is confirmed.
How do I know if this is a suitable procedure for me?
Your doctor has suggested this as the most suitable treatment for you. You may need to attend the radiology Pre-Assessment clinic to establish your general health. At this appointment you will need to have your blood pressure measured, a heart rate tracing performed and blood samples taken. A nurse will talk with you about these investigations. You will also be asked to give your consent for the procedure to go ahead following a detailed discussion with a radiologist (a doctor who specialises performing this procedure and reading scan images) or a senior nurse. There will be plenty of time during this appointment to answer any questions you may have. If you are already an in-patient in hospital, this will be discussed with you on the ward and the pre assessment completed by ward staff.
Who will perform the PTC?
A radiologist who has the special skills and training that is needed to perform a PTC.
Can I take my medication as normal?
Most medication can be taken as normal. If you are taking Metformin or any blood thinning medication such as Aspirin, Warfarin, Clopidogrel or Rivaroxiban, it is important that you let staff know at your Pre-Assessment appointment. If you are already an inpatient the ward staff will ensure that your medication is stopped according.
Please provide a full list of your medication.
What happens during the procedure?
On the ward
The procedure will require a hospital stay. You will be asked to go to a ward for a couple of hours to prepare before the procedure. On the ward you will be asked to put a hospital gown on and a cannula (plastic needle) will be inserted into one of your veins. You will not be able to eat and drink for 4 hours before the procedure (nil by mouth) as you may require sedation medication during the procedure. You will be given some antibiotics to reduce the risk of infection. The ward nurse will complete a safety checklist with you before leaving the ward.
In the x-ray department
The procedure is performed in the x-ray department. On entering the x-ray room a radiologist (x-ray doctor), radiographer (person who takes the x-ray pictures) and a nurse will greet you. They will check your personal details and discuss the procedure with you. If you have not previously signed a consent form this will be completed with you now. The safety checklist will be completed again in the x-ray department.
Before the procedure
You will be asked to lie flat on the x-ray table with a pillow under your head. It is normal to be sedated during the procedure. This will include treatment for pain relief .However you will remain rousable. You will have a trained nurse monitoring your condition who will also be there to support you and ensure your comfort.
Your blood pressure, oxygen levels and heart rate will be measured regularly. You will be given some oxygen to breath either through a mask or a soft tube that will sit into the end of your nostrils.
During the procedure
The skin above the access site in your abdomen will be cleaned and some local anaesthetic will be injected into the skin. It will sting briefly but in about 30 seconds the tissue will become numb. You may feel a little pressure as a thin catheter (tube) is put into place. The doctor will then use x-rays to see the position of this catheter. Contrast (x-ray dye) is injected through the catheter. X-rays will be taken at the same time and will identify the bile ducts and show any narrowed or blocked areas.
The doctor will position a drain into the bile ducts which in turn will be connected to a drainage bag. This will be secured in place with a dressing. Bile will drain away from blocked ducts and collect in the bag usually for at least 24 hours. The doctor will advise how long this needs to be in place as the length of time is unique to you.
If you require a stent, it will normally be placed in position when you return for the second time (normally a day or two after the first procedure). This procedure will also require further sedation. A drain will usually be left in place for at least another 24 hours, this will be removed when we are sure internal drainage of bile has been re-established.
After the drain is removed some oozing of bile from the puncture site is normal. The puncture site will be covered with a sealed bag to protect your skin and clothing. The puncture site will heal over the course of a few weeks and the bag can be removed once the bile stops oozing.
What happens after the procedure?
You will be helped back onto a trolley. There will be someone with you until the ward nurse arrives to escort you back to the ward.
You will need to remain on bed rest for 4 hours after your procedure and you will also remain nil by mouth for 4 hours or until your sedation medication has worn off. The ward staff will monitor you and will inform you when you can eat and drink normally again.
A nurse will observe your access site and drain regularly and continue to measure your blood pressure, oxygen levels and heart rate. If you feel any swelling, oozing or pain in the area of the access site, please inform the nurse immediately.
If you need to use the toilet during this time, please ask for a bedpan or bottle.
Please be aware of the drain and remember to pick it up when you are mobilising. The nursing staff will be able to help you to do this in the safest way.
You will be advised if you need to return to x-ray to complete the procedure.
Are there any risks?
The most common complication is the development of infection, if the bile is infected, although you may already be on antibiotics, there is a small risk that infection might be released into your bloodstream, making you unwell for a period.
There is a risk of bleeding, though this is generally very slight. If the bleeding were to continue, then it is possible that you might need a blood transfusion. Very rarely, an operation or another radiological procedure is required to stop the bleeding.
You may also be allergic to the x-ray dye.
Occasionally bile can leak around the catheter and this can be painful. Pain killers can be given. Very rarely this bile collection may need to be drained separately.
Please feel free to ask any questions at your Pre-Assessment appointment or to the ward staff.
How soon will I be back to normal?
After each part of your procedure you will need to stay in bed for a number of hours, this will depend on your procedure and the nurses will advise you.
You will be able to mobilise normally after this time- remember to take your drain with you.
Most patients require a hospital stay after the procedure. Your discharge date will be discussed with you on the hospital ward as the doctors monitor your progress.
What happens if I decide not to have the procedure?
You will be referred back to the doctor who recommended the PTC to discuss it further.
What if I have any special requirements?
If you have any special needs or requirements please discuss this with the nurse or doctor at your pre assessment visit or contact the x-ray staff on the number below.
Where can I get more information?
NHS 111