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Catheter tract hemorrhage during percutaneous biliary intervention: management with use of a retained transhepatic
E W Olcott1, R R Saxon, E J Ring
1Department of Radiology, University of California, San Francisco, USA.
Insights
Retained transhepatic guide wires effectively manage hemorrhage from immature biliary drainage tracts. This technique, essential before catheter removal, ensures hemostasis and prevents complications.
Area of Science:
- Interventional Radiology
- Hepatobiliary Medicine
Background:
- Hemorrhage from immature catheter tracts is a complication of biliary drainage.
- Managing such bleeding requires secure methods to prevent further injury.
Observation:
- Six patients (6/71) experienced significant hemorrhage within 4 days of biliary catheterization.
- Hemorrhage occurred during drain manipulation when catheters were removed.
Findings:
- Utilizing retained transhepatic guide wires controlled hemorrhage in all six patients.
- Reintubation over the guide wire was definitive in five patients.
- One patient with a biliary-portal venous fistula was successfully treated with thrombin.
Implications:
- Retained transhepatic guide wires are crucial for managing hemorrhage from immature biliary catheter tracts.
- This method offers definitive control and should be standard practice before hepatic catheter removal.
- Shorter biliary catheterization courses may increase the incidence and importance of this management technique.
Purpose:
The authors present their experience in managing freely flowing hemorrhage from immature catheter tracts in patients undergoing biliary drainage.
Patients And Methods:
Transhepatic guide wires were maintained securely whenever catheters were removed from the liver. Six patients among 71 hemorrhaged profusely when drains were manipulated within 4 days of initial catheterization. Management was attempted with use of the transhepatic guide wires.
Results:
Maneuvers performed over the retained guide wire controlled bleeding in all six patients. Reintubation constituted definitive therapy in five patients. A biliary-portal venous fistula in the remaining patient was treated with thrombin. The retained guide wire proved necessary in all cases.
Conclusion:
Hemorrhage from immature catheter tracts can be managed, often definitively, with maneuvers performed over a retained transhepatic guide wire. Accordingly, a secure transhepatic guide wire is essential prior to removal of hepatic catheters and should remain in place until the absence of bleeding is established. These maneuvers may become increasingly important as courses of biliary catheterization become shorter.