Appointments – Freeman Hospital: (0191) 223 1012 : RVI: (0191) 282 5627
What is a Percutaneous Biliary Drainage?
You have what is called “obstructive jaundice” which is usually caused by a blockage in the bile duct between the liver and the duodenum. In order to relieve the blockage, a tube is inserted through the skin and into the liver to drain the bile. The drainage tube takes bile fluid from the liver into a collecting bag outside the body.
What is a Biliary Stent?
The ordinary biliary drainage tube hangs outside the body and is connected to a bag. A biliary ‘stent’ is an ‘inner tube’, which can be used to replace the externally draining system. It is a short, fine plastic or metal tube, which is usually inserted at the same time as the external tube is taken out.
Who decided that I needed this procedure?
Your doctors will have discussed the possible treatment options with the interventional radiologist (X-ray doctor) responsible for performing these procedures. There will be an opportunity for you to discuss the treatment with your doctors and with the interventional team. This is a good time to mention any allergies or other conditions you have. You will be asked to sign a consent form after you have fully considered all the advice given. If you do not want to undergo this treatment, then the procedure will be taken no further.
You will need to be admitted to hospital in order to undergo this treatment. You will be asked to put on a hospital gown and you will be examined by the doctors and nurses on the Ward It is very important that you inform the nursing and medical staff about all allergies and medications. If you have had reactions to intravenous contrast medium, the dye used for kidney X-rays (IVPs) and for CT scanning, then you must also tell your doctor about this. A small plastic cannula will be inserted into an arm vein so that antibiotics may be given. Infection is often present in the obstructed bile duct, which is why you will be given antibiotics prior to attending the X-ray department.
You may eat a light meal at least 2 hours prior to the procedure and fluid intake should not be restricted.
What happens during a Biliary Drainage?
After the admission procedures on the ward, a nurse will accompany you to the X-ray Department. Here, the radiology nurse will discuss basic details of the procedure with you and the interventional radiologist will answer any further questions you may have. You will be transferred onto the X-ray table, on your back. Monitoring devices will be attached to your chest and one finger. A blood pressure cuff will be put on your arm.
To aid relaxation through the procedure, sedative drugs are given soon after you get onto the table. Your skin will be cleaned with antiseptic in the low right side of your chest and local anaesthetic (see below) will be injected into the skin and soft tissues. A fine needle is inserted into the liver and a guide wire passed through this. The needle is removed over the wire and replaced by a fine plastic tube or ‘catheter’, which is then passed through the obstruction in your bile duct using the X-rays as a “road map”. The catheter will then be fixed to the skin and a drainage bag attached. The length of the procedure can vary, but expect to spend up to one and a half hours in X-ray.
Local Anaesthetic
- Your radiologist will ask you to keep quite still while the injections are given.
- You may notice a warm tingling feeling as the anaesthetic begins to take effect.
- Your procedure will only go ahead when you and your radiologist are sure that the area is numb.
- If you are not having sedation, you will remain alert and aware of your surroundings. A screen shields the operating site, so you will not see the procedure unless you want to.
- Your radiologist is always near to you and you can speak to him/her whenever you want to.
Will it hurt?
There may be some discomfort as the needle track through the liver is stretched to allow passage of the drainage tube. At this point, a strong pain-killing drug is often injected through the tube in your arm and you will feel slightly drowsy. Oxygen may be given through a face mask.
What happens afterwards?
On your return to the ward, you will have to lie flat in bed for six hours. The nurses will monitor your blood pressure and pulse frequently during this period. You will then be able to move gently around the ward. The drainage bag will be emptied regularly and the contents measured. The length of time that the external drain remains in place will depend on your condition and will be discussed by your doctor.
What are the risks and complications?
There is often a small leakage of bile around the drainage tube but this is usually a minor problem.
Biliary drainage is a safe procedure but there are two main complications, occurring in less than 5% of cases: bleeding around or into the liver and infection of the blood stream.
When bleeding occurs it is often not significant. Occasionally, this can increase and lead to the need for blood transfusion but can increase and may then lead to blood transfusion. Very rarely, a small operation is needed to block the bleeding artery.
In a few cases, bacteria may enter the bloodstream causing an infection, which will require continued antibiotics through the plastic tube in your arm.
What if I have any comments, questions or suggestions?
Should you have any suggestions or concerns, please make these known to the person conducting your examination or by letter addressed to the hospital that you are attending your examination:
The Departmental Manager
X-ray Department Level 3, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP
Telephone: (0191) 282 1099
Or:
The Departmental Manager
Main X-ray Department, Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN
Telephone: (0191) 282 1099
Monday to Friday 8.30am to 5.00pm
Switchboard: (0191) 233 6161 (24 hours)
The Patient Advice and Liaison Service (PALS) can offer on-the-spot advice and information about the NHS. You can contact them on freephone 0800 032 02 02 or email northoftynepals@nhct.nhs.uk
Diagnostic Imaging Dataset
Information from your diagnostic test will contribute to the Diagnostic Imaging Dataset.
The Diagnostic Imaging Dataset (DID) is a database that holds information on the imaging tests and scans carried out on NHS patients. This will allow the Health and Social Care Information Centre to see how different tests are used across the country.
Nothing will ever be reported that identifies you. All information is stored securely. It is only made available to appropriate staff, and is kept strictly confidential. However, if you do not want your information to be stored in the DID, please tell the people who are treating you. They will make sure your information is not copied into the DID.
You may, at a later date, still decide to opt out. Please contact the Health and Social Care Information Centre directly, their contact details are:
Telephone: 0845 300 6016
Email: enquiries@ic.nhs.uk
Website: www.ic.nhs.uk
Produced by: Dr J Rose, Clinical Directorate of Radiology
