Percutaneous transhepatic biliary drainage (PTBD)

Ricki's new liver is having bile duct issues, which is more common in LDLT (living donor liver transplant) Statistics show about 10% of transplant patients that receive cadaver livers have biliary problems, but the number jumps to about 35% for LDLT patients. Since the drain has been placed, my bilirubin has dropped from the low 20's to 7 (normal is under 2) I am less itchy and already much less jaundiced. Since this drain is placed between the ribs and through the diaphragm it starts off pretty painful but after a while, just becomes uncomfortably bearable. Since stents had been unsuccessfully placed previously, this is my last option before surgery. I know for many of us liver patients, feeling a little sick is a daily feeling for us, but if you notice anything "un-normal" (I started feeling like I did just before my transplant) get yourself checked out... Following is more information on the PTBD.

Percutaneous transhepatic biliary drainage (PTBD) is a procedure that is done to open a blocked bile duct. Your bile duct is like a network of pipes that go from your liver to your gallbladder, pancreas, and small intestine (bowel). Your liver is an organ that makes fluid called bile, which is stored in your gallbladder and helps you digest food. Digestion is the process of the body breaking down food that is eaten. When bile reaches your small intestine, it helps break down the fat in your food. The pancreas is an organ that helps you digest food.

With PTBD, your body may digest food more easily. Abdominal pain and jaundice (yellowing of your skin and the whites of your eyes), may decrease. PTBD can help you get the nutrition that you need to feel better and be healthier.

  

Why may I need percutaneous transhepatic biliary drainage?

You may need PTBD if your bile duct is blocked. A disease called cholangitis causes swelling, which blocks your bile duct. Abnormal growths and small bile stones may block your bile duct. Trauma (an accident) or a scar from a past surgery also increase the risk of getting a blocked bile duct. Ask your caregiver to explain how your bile duct may have become blocked.

What tests may I need before or during percutaneous transhepatic biliary drainage?

Tests such as fluoroscopy, magnetic resonance imaging (MRI), and computed tomography (CT) may be needed before and during your procedure. These tests take pictures of your body organs and areas. Dye may be used to help caregivers see the pictures. Tell caregivers if you are allergic to dyes, iodine or seafood, as you may also be allergic to the dye used for these tests.

What happens during percutaneous transhepatic biliary drainage?

Your caregiver will put a needle through the right side of your abdomen and into your liver. A wire will be pushed through the needle into your liver. Your caregiver will use the wire to break up stones blocking your bile duct. Your caregiver will put a tube over the needle and then remove the needle and wire. A small part of the tube will come through your skin to the outside of your body. If the tube is capped closed, bile will drain into your intestines. If the tube is left open, bile will drain into a bag that is attached to the end of the tube outside of your body. You may need to have a PTBD tube for a short time, or it may be long-lasting.

What are the risks of percutaneous transhepatic biliary drainage?

• You may be allergic to the dye used for tests that are done before or during the procedure, and have an allergic reaction. Your gallbladder, bile duct, or blood vessels may be damaged. You may lose too much blood and need a blood transfusion. After the procedure, there may be swelling or bleeding around the tube, and it may be painful. The skin around the tube may get infected. The tube may move out of place or get blocked. Your gallbladder may become swollen or infected. You could get a blood clot in a blood vessel in your liver. You could get a lung infection, or your lungs could fill with blood or air, making it hard for you to breathe.
  
• If you do not have percutaneous transhepatic biliary drainage, you may not have enough bile in your intestines to digest food. Because of this, your body may not get the nutrition it needs. Bilirubin may build up in your liver and bile duct. You may get jaundice, causing your eyes and skin to turn yellow. Your gallbladder may burst. With or without PTBD, you may die from infection. Call your caregiver with questions about your condition, the PTBD procedure, or your care.

How do I care for the tube after percutaneous transhepatic biliary drainage?

Ask your caregiver how to care for your tube and the skin around it. If bile is draining out of your body into a bag, you will need to make sure there is bile in the bag. Ask caregivers how much bile should be in the bag and what color it should be. You will need to make sure the PTBD tube is not blocked. Ask caregivers when to flush (clear out) the inside of the tube, and to show you how to flush it.

When should I call my caregiver?

Call your caregiver if:

• You cannot make it to your procedure or your appointments.
  
• Your skin or the whites of your eyes look more yellow than usual.
  
• You have a fever (increased body temperature).
  
• You are nauseated (feeling sick to your stomach) or you are vomiting (throwing up).
  
• Your stool (bowel movements) have changed color, and are very dark or very light.

When should I seek immediate help?

Seek care immediately or call 911 after surgery if:

• There is little or no drainage from the tube into the bag.
  
• You have severe (very bad) pain in your abdomen, or your abdomen feels hard or is swollen.
  
• You are coughing or throwing up blood.
  
• You are dizzy, or you feel too weak to stand up.
  
• You have new trouble breathing.
  
• Your tube falls out.
  
• Your stools look red, or you see blood when you go to the bathroom.

Care Agreement

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.
Copyright © 2011. Thomson Reuters. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.
The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.


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