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Biliary stent placement and biliary drain replacement Technique and Dictation

Procedures:  

  • Cholangiogram through existing catheter
  • Biliary covered metallic stent placement
  • Biliary catheter replacement          

 

Indication: Pancreatic cancer and biliary obstruction

Date:     

Operators:     

Medications:     mg IV Versed,     mcg IV fentanyl and 3.375 gm IV Zosyn

Contrast:     mL non-ionic

Fluoro time:      minutes

Catheter:     F Amplatz anchor external biliary drain

Device:  0 mm x     cm Gore VIABIL covered biliary stent

Complications:  None immediate

 

Technique: 

The risks, benefits, and alternatives to the procedure and sedation were explained to the patient. The specific risks of stent mal deployment or migration and sepsis were detailed and accepted. Written informed consent was obtained.  A time out/call to order was performed prior to procedure initiation.

The existing catheter and surrounding soft tissues were prepped and draped in sterile fashion. Local anesthetic was injected at the catheter entry site.

Contrast was injected through the existing biliary drainage catheter and cholangiographic images obtained.

A wire was negotiated through the catheter and into small bowel.   The catheter was removed over the wire, and a short 10 French sheath placed.   A 5 French marker pigtail catheter was placed over the wire into small bowel. A  cholangiogram was performed through the sheath and pigtail, demarcating the location of the ampulla and biliary confluence.

Lesion length was measured and the Viabil stent advanced over the wire and positioned using fluoroscopy.  The stent was deployed, and the sheath re-injected.  The lesion and stent were dilated with a     mm balloon.  A final cholangiogram was performed through the sheath.

A new,    F Amplatz anchor was placed over the wire  The catheter was positioned    .   The catheter was secured to the flank in the usual manner.  The tube was capped or attached to gravity drainage.

The procedure was well tolerated, and the patient discharged in satisfactory condition.

 

Findings: Comparison is made with    .

  1. A     stricture extends from the    , consistent with     cancer.
  2. The covered stent is appropriately positioned, extending from    .  
  3. There is prompt antegrade flow through stent on the completion cholangiogram.
  4. additional findings.

 

Impression:

  1. Malignant stricture of the     secondary to     cancer.
  2. A covered stent was successfully deployed.
  3. The intrahepatic bile ducts are     dilated.

 

Plan:

when will pt return?

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