PTBD

What is PTBD?

Percutaneous Transhepatic Biliary Drainage (PTBD) is a procedure in which a small tube, or catheter, is inserted through your skin into the liver when there is a blockage in your bile ducts (due to stones or tumour). The collected bile is then stored in an attached drainage bag. The procedure is guided by imaging techniques. It's important to follow the care instructions to keep it working properly and avoid complications.

Preparation for the Procedure

Before the procedure, a blood test may be done to check for clotting issues. Inform your doctor and the Radiology Department about any medications you are taking. If you are on blood thinners, these may need to be stopped 3-5 days before the procedure.

• Fasting for 4-6 hours before the procedure is generally recommended, especially if sedation or anesthesia is involved. Arrive early to allow time for registration and other formalities. If the procedure is outpatient, arrive 20 minutes before your scheduled time; for a day-case or inpatient procedure, arrive at least 2 hours ahead. Remove jewelry, makeup, and anything metallic.If you feel unwell (fever, sore throat, or flu-like symptoms) before the procedure, inform your doctor.

What Happens During PTBD?

The procedure is performed by an Interventional Radiologist in the Radiology Department, usually under conscious sedation with the help of an anesthetist who will monitor your vital signs. The procedure is done under sterile conditions. First, a local anesthetic is applied to the area where the catheter will be inserted. A fine needle is then guided using ultrasound and X-ray to reach the bile ducts. A contrast agent is injected to confirm proper placement. A guidewire and catheter are then threaded through the blockage and into the first part of small intestine. The catheter is then secured to the skin and connected to a drainage bag.

After the Procedure

You will have a drainage catheter inserted into your bile ducts, and you'll be taken to the recovery area to be monitored until the sedation wears off. You might stay overnight in the hospital, but some patients go home the same day.

Caring for the Biliary Drainage Catheter

Please follow these instructions for catheter care:

• Ensure the catheter is secure, and there is no tension on the tubing. Attach the bag to your clothing using a pin or Velcro straps
• Regularly check the catheter to ensure it is not broken, kinked, or obstructed by anything.
• Observe the appearance of the bile, including its color and concentration, and keep track of the amount of bile drained each day.
• Empty the drainage bag regularly to prevent it from becoming too heavy, which could dislodge the catheter.
• Your nurse will teach you how to flush your catheter with saline to keep it clear. You may need to do this daily.
• Change the bag and dressing weekly or if they become dirty or loose.

When to Call Your Doctor:

• Contact your doctor immediately if:
  • The catheter has moved more than five centimeters or has become dislodged (Check the black ink mark on your catheter. It should stay the same distance from the disk.)
  • There is blood in the drainage or leakage around the catheter or the bandage has shifted or fallen off.
  • There is no bile flow for 24 hours, or if the flow is significantly reduced.
  • There is pain, redness, swelling, or irritation around the insertion site.
  • You cannot flush the catheter
  • You develop a high fever.

Routine Care & Catheter Changes:

• You can bathe as usual but avoid getting the wound wet or dirty. If the bandage becomes soaked with water, clean the wound after bathing and replace the bandage. Do not submerge the catheter in water or swim.
• Clean the wound twice a week or as needed by following these steps:
  • Wash your hands thoroughly with soap and dry them with a clean towel.
  • Use a clean cotton ball soaked in Betadine solution to gently clean around the wound and the catheter.
  • Since the catheter moves with your breathing, clean the same area again using a cotton ball soaked in 70% alcohol solution.
  • Cover the wound with sterile gauze, then secure the catheter with a bandage to prevent it from bending.
  • Ensure the catheter is properly fixed to your abdomen using the bandage.
• Visit the hospital monthly or as recommended by your doctor to have the collecting bag changed.

Benefits and Risks

Benefits:

• Minimally invasive
• No general anesthesia required.
• Relieves bile obstruction, preventing pain, infection, and preserving liver function
• PTBD may be the only option when surgery or endoscopy isn't feasible.

Risks: While the risks are generally low, they may include:

• Bleeding at the puncture site or internally (rarely requiring a transfusion or intervention).
• Infection at the insertion site
• Infection spreading into the bloodstream if the drained bile is infected
• Accidental injury to nearby organs (e.g., lungs or intestines), though image guidance reduces this risk.
• Pain or discomfort at the insertion site.
• Allergic reactions to the contrast agent.

Alternatives

Surgical or endoscopic treatments may also relieve the obstruction, and these options should be discussed with your doctor.

Biliary Stenting

If the obstruction is long-term or permanent, a stent (a plastic or metal tube) might be inserted to keep the bile ducts open. This can be done either through the skin by the Interventional Radiologist or using endoscopy. If successful, the drainage catheter can be removed. Your doctor will discuss this option with you.