Patient Name: ,
DOB: SEX:
Ordering Physician: ,
PROCEDURE:
- Sheath cholangiogram
- Biliary catheter replacement
INDICATION:
DATE:
OPERATORS: John Doe, MD (Attending)/Jane Doe, MD (Fellow)
MEDICATIONS: Versed mg IV, fentanyl mcg IV, Zosyn 3.375 gm IV
CONTRAST: ml non-ionic contrast
FLUOROSCOPY TIME: minutes
CATHETER: French biliary drain
COMPLICATIONS: None
TECHNIQUE: The risks, benefits, and alternatives to the procedure and sedation were explained to the patient. The specific risk of sepsis was detailed and accepted. Written informed consent was obtained.
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 tube to confirm position.
A 0.035″ glidewire was negotiated through the catheter into the small bowel. The catheter was removed and a 5F Kumpe catheter was used to exchange the glidewire for a 0.035″ Amplatz guidewire. The Kumpe was exchanged for a ____ French sheath. A pull back sheath cholangiogram was performed.
The sheath was removed and a new ____French Bentec internal/external biliary drain was placed coaxially over a____ French Van Andel catheter. Contrast was injected to confirm tube position. The tube was ______. The catheter was secured to the skin with 2-0 Ethilon. The patient tolerated the procedure well without immediate complications.
FINDINGS: Comparison is made to a prior study dated .
- Cholangiogram through the catheter demonstrates ______
- The new catheter is appropriately positioned with the distal tip in the _____ and the proximal side hole in a peripheral bile duct.
IMPRESSION:
- Uneventful image guided replacement of a biliary catheter as described.
PLAN:
Frequently Asked Questions
What is a biliary cholangiogram?
A biliary cholangiogram is an imaging test that uses X-rays to view the bile ducts. This procedure often involves injecting a contrast dye into the bile ducts to make them visible on the X-ray. It is used to assess the condition of the bile ducts, check for blockages, and guide procedures like catheter placement or replacement.
A biliary drain change involves removing an existing biliary catheter and replacing it with a new one. The procedure is performed under fluoroscopy, a type of real-time X-ray, to ensure accurate placement. A guidewire is used to maintain access to the bile ducts while the old catheter is removed and a new one is inserted. The new catheter is then secured in place.
What are the risks of a biliary catheter replacement?
The primary risks associated with biliary catheter replacement include infection, bleeding, and injury to the bile ducts or surrounding organs. There's also a risk of sepsis, which is a severe infection that spreads throughout the body. However, these procedures are generally safe when performed by experienced medical professionals, and the risks are minimized with proper technique and sterile conditions.
Why is Versed used during biliary procedures?
Versed, also known as midazolam, is a medication used for sedation during medical procedures. It helps relax the patient, reduce anxiety, and induce a state of calmness. In the context of biliary procedures, Versed is used to ensure patient comfort and cooperation, as these procedures can be uncomfortable or anxiety-inducing.
What does a successful biliary catheter replacement look like?
A successful biliary catheter replacement is indicated by the correct positioning of the new catheter, with the distal tip placed in the intended location, such as the small bowel, and the side holes located in a peripheral bile duct. The patient should experience no immediate complications, and the catheter should function properly to drain bile.
What is the role of contrast in a biliary cholangiogram?
Contrast dye is crucial in a biliary cholangiogram as it highlights the bile ducts on X-ray images. By injecting contrast into the ducts, doctors can see detailed images of the duct anatomy, identify blockages or abnormalities, and ensure that a catheter is correctly placed. This visualization is essential for diagnosing issues and guiding procedures.
How do you prepare for a biliary catheter replacement?
Preparing for a biliary catheter replacement involves obtaining informed consent after explaining the procedure's risks and benefits to the patient. The existing catheter site is cleaned and draped in a sterile manner. Local anesthetic is applied to minimize discomfort, and the procedure is performed under fluoroscopy to ensure precision and safety.