BILIARY CHECK/CHANGE FOR ANCHOR
Patient Name: <<Patient Last Name>>, <<Patient First Name>>     Â
DOB: <<Patient DOB>>Â Â SEX: <<Patient Sex>>
Ordering Physician:Â <<Ordering Last Name>>, <<Ordering First Name>>
PROCEDURE:Â
- Sheath cholangiogram
- Biliary catheter exchange
INDICATION: []
DATE: []
OPERATORS: Â John Doe, MD (Attending)/Jane Doe, MD (Fellow) Â Â Â
MEDICATIONS: Versed [] mg IV, fentanyl [] mcg IV, and Zosyn 3.375 gm IVÂ
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.Â
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.Â
The procedure was well tolerated, and the patient discharged in satisfactory condition.
FINDINGS: Comparison is made to a prior study dated [].
- Cholangiogram images demonstrate []
- 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.
Frequently Asked Questions
What is a biliary drain check and change procedure?
A biliary drain check and change procedure involves assessing and replacing a biliary catheter. This catheter helps drain bile from the liver to the intestine. The procedure includes using imaging techniques like cholangiogram to ensure correct placement and function of the drain, and it minimizes risks like infection or blockage.
What is an Amplatz anchor in biliary procedures?
An Amplatz anchor is a type of catheter used in biliary procedures to help maintain the drainage of bile from the liver. It is positioned near the biliary enteric anastomosis, a surgical connection between the bile duct and the intestine, to ensure that bile flows properly and prevents blockages.
The biliary catheter exchange is performed by first injecting contrast to confirm catheter location. A guidewire is then inserted, the old catheter is removed, and a new catheter is placed over the guidewire. The new catheter is positioned and secured to ensure proper bile drainage.
What are the risks and benefits of a biliary drain change?
The risks of a biliary drain change include infection, bleeding, and potential sepsis. However, the benefits include improved bile drainage, reduced risk of liver inflammation or jaundice, and prevention of bile duct blockages. Informed consent is obtained after explaining these risks and benefits to the patient.
What is a cholangiogram and why is it used?
A cholangiogram is an imaging test that uses contrast dye to visualize the bile ducts. It is used during biliary procedures to confirm the position and function of the bile ducts and catheters, ensuring they are correctly placed for optimal bile drainage.
Why is sedation used in biliary procedures?
Sedation, using medications like Versed and fentanyl, is used in biliary procedures to keep the patient comfortable and pain-free. It helps reduce anxiety and discomfort during the procedure, allowing for a smoother and safer experience for both the patient and the medical team.
What should a patient expect after a biliary catheter exchange?
After a biliary catheter exchange, the patient can expect some mild discomfort at the catheter site. They will be monitored for a short time to ensure there are no immediate complications. The patient is usually discharged in a stable condition with instructions to return for follow-up tests, such as a Whitaker test, to assess bile flow.
How is the catheter secured during a biliary procedure?
The catheter is secured during a biliary procedure using sutures, such as 2-0 Ethilon, to attach it to the skin. This helps prevent the catheter from moving or becoming dislodged, ensuring it stays in the correct position to facilitate proper bile drainage.
What is the purpose of a Whitaker test after a biliary procedure?
A Whitaker test is performed after a biliary procedure to measure the pressure in the bile ducts and confirm the effectiveness of the drainage. It helps determine if the catheter is functioning properly and if the bile ducts are clear, guiding further treatment or the removal of the catheter.
Why are serum bilirubin levels checked after a biliary drain change?
Serum bilirubin levels are checked after a biliary drain change to assess how well the liver is processing and eliminating bile. High bilirubin levels can indicate issues with bile flow or liver function. Monitoring these levels helps ensure the procedure was successful and that the liver is functioning properly.