Percutaneous Transhepatic Cholangiography ( PTC )

 Percutaneous Transhepatic Cholangiography ( PTC )

PTC is an x-ray procedure that involves direct-inject of contrast medium in the bile duct.

These are the ducts that carry bile from the liver to the gallbladder and small intestine

In this procedure, a thin needle is directly inserted through the skin into the liver to reach the bile duct.

  • Indications
  • Contraindication
  • Equipment
  • Patient Preparation
  • Procedure
  • Aftercare
  • Complication
                Indications

  • ERCP procedure is failed
  •  Strictures in the bile duct
  • Suspected bile duct obstruction
  • Billary system delineation in the presence of intra and extrahepatic biliary calculi
  • Cause of Jaundice
  • Suspected tumor
  • Anatomic evaluation of complications of ERCP 
                   Contraindications

  • Suspected pregnancy
  • Allergic to contrast medium
  • Bleeding tendency
  • Gross Ascites - Fluid in the abdominal cavity
  • Sever infection at the puncture site
  • Chronic liver disease
  • Billary tract sepsis
           Equipment

Fluoroscopic unit with spot film light with IITV 

Ultra Sonography Machine

Chiba needle(22G.15cm long)

Water-soluble nonionic contrast medium

Antiseptic solution

Syringe

Gaz piece

Bandage

Sterile towel



                  Patient preparation

Describe the procedure to Patient

Ask the patient for previous contrast allergy

The patient shall have not to eating or drinking

Obtain the patient consent

            Procedure 

Place the patient in a supine position on a fluoroscopic table

An intravenous (IV) line should be given 

Monitoring of BP, Pulse, Blood oxygen

The patient right side rib cleaned with an antiseptic solution

Inject a needle into the liver and ask the patient to hold their respiration 

Chiba needle inserted should be done under fluoroscopic & ultrasound guidance

Then gently push the needle through the liver into the bile duct

Then a needle is attached to the syringe

After insertion of needle successfully contrast media is injected and radiographs are taken

The introduction of contrast media should be done under fluoroscopic gudince.

After injecting contrast media into the intrahepatic bile duct, we need to take in the AP supine position.

Radiographs

Left anterior oblique

Right anterior oblique

Abdomen AP View

                        Aftercare

Applied proper dressing on puncture site

Remove The chiba needle

keep patient in proper observation

                Complications

Bile duct leakage

Bleeding

Infection on puncture side

liver hemorrhage









 













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