BILIARY CHECK/CHANGE FOR ANCHOR

Patient Name:  <<Patient Last Name>>,  <<Patient First Name>>      

DOB: <<Patient DOB>>    SEX: <<Patient Sex>>

Ordering Physician:  <<Ordering Last Name>>, <<Ordering First Name>>

 

PROCEDURE: 

  1. Sheath cholangiogram
  2. Biliary catheter exchange

INDICATION: []

DATE: []

OPERATORS:   John Doe, MD (Attending)/Jane Doe, MD (Fellow)     

MEDICATIONS: Versed [] mg IV, fentanyl [] mcg IV, and Zosyn 3.375 gm IV 

CONTRAST: [] ml of non-ionic contrast

FLUOROSCOPY TIME: [] minutes

CATHETER: [] F x 30 cm Amplatz anchor

COMPLICATIONS: None immediate

 

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. A surgical time-out was performed confirming correct patient, correct procedure, and laterality.

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 location.

A 0.035 inch Glidewire was advanced through the existing Bentec catheter into the small bowel. The catheter was removed and a 5 French Kumpe catheter was used to exchange the Glidewire for a 0.035 inch Amplatz guidewire. The Kumpe was removed and a [] French sheath was placed over the wire.  A pullback cholangiogram was performed through the sheath. 

The sheath was removed and a 10 French x 30 cm Amplatz anchor was advanced over the guidewire and positioned proximal to the biliary enteric anastomosis. Contrast was injected to confirm location. The tube was flushed and capped. The catheter was secured to the skin with 2-0 Ethilon. A sterile dressing was applied. 

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

 

FINDINGS: Comparison is made to a prior study dated [].

  1. Cholangiogram images demonstrate []
  2. The Amplatz anchor is positioned proximal to the biliary enteric anastomosis.

 

IMPRESSION: Widely patent biliary enteric anastomosis with exchange of the internal-external biliary drain for an Amplatz anchor.

 

PLAN: The patient should return in one week for a Whitaker test and possible tube removal. Serum bilirubin levels will be checked at this time.