Percutaneous transhepatic cholangiography, or PTC, is a way of examining the bile duct system in the liver. This procedure is done under local anesthesia by a radiologist. During the exam, a thin needle is inserted through the skin (percutaneous) and through the liver (transhepatic) into a bile duct. Then dye is injected, and the bile duct system is outlined on x-rays (cholangiography).

Why is PTC done?

Bile is a body fluid that helps your body digest fats. It is produced by the liver and collected in tiny bile ducts that empty into increasingly larger ducts. Finally, a main bile duct carries bile to the small intestine. Bile also is stored in the gallbladder.

When one or more bile ducts narrows or has a blockage, bile may back up and cause problems such as jaundice, a yellowing of the skin. Or, a leak in a bile duct may allow bile to flow into the abdominal cavity.

PTC allows your doctor to see on the x-rays if the ducts are partially or completely blocked. If necessary, a thin, flexible tube (catheter) may be inserted to allow the bile to drain into a collection bag outside the body, or into the small intestine. This procedure is called biliary drainage.

The drawing below shows the liver with the bile duct (biliary) “tree,” and the PTC needle inserted into a bile duct.

Before your PTC procedure

Ask your doctor how long you must fast before your PTC.

In some hospitals, a radiologist will visit you and describe the PTC procedure. He or she also may discuss biliary drainage with you in case you need to have this procedure done during the PTC.

You will be asked to sign a consent form that gives your permission to have the procedures.

You also will be asked if you are allergic to any medications, especially antibiotics or iodine. Be sure to tell your doctor and nurse if you have these allergies or if you have had any reactions to antibiotics or x-ray dye. This information will help your doctor and nurse to plan your care during the procedure. An intravenous (IV) line will be placed in a vein in your arm so that you can receive medications during the procedure.

You will be taken on a stretcher to the lab where PTC is done. A nurse or x-ray tech will help you get on the examination table. Patches may be placed on your chest and a blood pressure cuff will be placed on your arm so that staff may monitor your heart rate and blood pressure during the procedure.

You will receive medications through your IV to help you relax. You will be awake during the procedure and will be able to talk with those around you.

The PTC procedure

The skin on the right side of your abdomen will be cleaned with special soap, and the
area will be draped with sterile cloths. Your skin will then be numbed with a local anesthetic.

Once the area is numb, the doctor will insert a thin needle through your skin, between the ribs, through the liver, into a bile duct. As the needle is withdrawn, a small amount of dye will be injected and x-rays will be taken. If you have any discomfort, please tell your doctor or nurse. He or she can give you medication to relieve any discomfort you may feel.

If the PTC results show a problem, such as a blockage in the bile duct, the doctor may replace the thin needle with a small drainage tube (catheter) that will bethreaded into the small intestine (see illustration). A small pouch may be attached to the end of the catheter outside your body to collect bile.

PTC usually takes about one hour to perform. If a drainage tube needs to be inserted, the procedure may take longer, depending on how easily the tube can be threaded through the bile duct.

After the procedure

Following the procedure, your heart rate, temperature, breathing, and blood pressure will be checked frequently. The bile in the collection pouch also will be checked for color, amount, and presence of of antibiotic medication through your IV to prevent infection.

Going home with a catheter in place

If you are to be discharged with a catheter in place, your nurse will teach you how to care for the catheter at home. You may need to learn how to change the bandage around the catheter, how to do daily irrigations through the tube (flushing the catheter with water), and what to do about showering or bathing.

Bandage Changes

Your doctor will tell you how often the bandage around the catheter needs to be changed. Change it any time it becomes soiled or wet. To change your bandage, first gather all the materials you will need and place them near you. Then wash your hands thoroughly with warm water and soap. To change the bandage, do the following steps:

Remove the old bandage.
Soak a cotton swab in hydrogen peroxide and clean the area carefully. Or you may be told to use warm water and soap. Be careful not to put any pressure on the catheter and not to pull on it at any time.
Inspect the skin around the catheter for redness, tenderness, or drainage. Also check to see that the catheter has not changed position. Call your doctor if you notice any of these signs.
Slit a 4-inch by 4-inch gauze square from one side to the middle of the gauze and place it around the catheter on top of the disc. Slit a second 4-inchsquare gauze pad in the same way and place it around the catheter on top of the first bandage. Make sure the slitsare on opposite edges when the pads are on top of each other. Do not place a gauze bandage under the disc; this could cause the catheter to pull out.
Cover the bandage completely with strips of tape.

Irrigations

Your doctor may want your catheter to be capped. A cap, rather than a collection bag, on the outside end of the catheter will allow bile to flow directly into the small intestine. If the catheter is to be capped, you may need to flush (irrigate) the catheter periodically to keep it from becoming clogged.

Your doctor will tell you if the catheter is to be capped. Ask your doctor if you will need to irrigate the catheter. Your doctor or nurse will tell you how to irrigate your catheter if it is capped. If fluid will not go into the catheter when you try to irrigate it, you should stop trying to irrigate the catheter and call your doctor immediately.

Showering
You may shower with the catheter in place, but you will need to cover the gauze bandage. To cover the bandage, place a piece of plastic wrap over the bandage and tape all the edges of the plastic wrap to prevent water from seeping in. If the bandage becomes wet or damp, follow the steps listed previously to change the bandage.