Percutaneous Transhepatic Biliary Drainage (PTBD)

Percutaneous Transhepatic Biliary Drainage (PTBD) is a medical procedure for diagnosis or treatment of a bile duct obstruction. The objective of the procedure is to locate the obstruction and/or to insert a temporary catheter to drain the bile. This is an option for patients who would like to avoid surgery or for whom surgery would be too risky as this procedure has fewer side effects than surgery.

Risks and Complications
  1. Intra-abdominal bleeding; bleeding in the bile duct.
  2. Infection of the skin where the catheter is inserted and infection in the bile duct.
  3. Allergic reaction to contrast media during the procedure.
  4. Catheter dislodgement.
  5. Bile leakage.
Please care for your catheter as follows:
  1. Notice the appearance of the bile, such as the color and concentration, and record the amount of bile released each day.
  2. Notice the position and appearance of the catheter to ensure it is not broken, folded, bent or caught on something.
  3. You should see your doctor immediately if:
    • The catheter has been dislodged or moved more than five centimeters.
    • Bile leaks through the bandage or the bandage has moved or fallen off.
    • No Bile flows within 24 hours or less than usual.
    • You have a high fever.
  4. You can take a bath normally. Avoid getting your wound wet or dirty. If your bandage becomes wet enough that it soaks to the gauze below, clean the wound after bathing and place a new bandage on it. Do not soak in water or swim while the catheter is attached.
  5. Clean your wound twice a week or as needed. Follow these instructions
    • Wash your hands with soap two to three times and wipes them dry with a clean cloth before changing the dressing.
    • Use a clean cotton ball soaked in a Beta dine solution to wipe around the wound and the catheter attached to the skin. Since the catheter moves in and out as you breathe, use a cotton ball soaked in a 70% alcohol solution to clean the same area again.
    • Cover the wound with sterile gauze, and then place a bandage over the catheter to attach it to your abdomen to prevent it from being bent.
    • Use a bandage to attach the catheter to your abdomen to keep it in place.
  6. Come in to the hospital to change your collecting bag every month or as recommended by your doctor.
Some patients with obstruction in the bile duct system may not be eligible for the percutaneous transhepatic biliary drainage (PTBD) for several reasons, such as prolong coagulation, sepsis, massive ascites, cancer that has spread to the liver and multiple blockages in the bile duct system. This group of patients may have to consider alternative procedures to alleviate their symptoms.

Duration Retained Catheter
You will probably need to keep the catheter for two to three weeks or until bile flows into the intestines normally. This depends on the doctor’s treatment plan. If this procedure is part of palliative care, you may have to keep the catheter for the rest of their life.
After you are discharged, it is recommended that you stay at a hotel close to the hospital for at least two days for convenience in traveling to the hospital if any complications arise after the procedure.
  1. Endoscopic Retrograde Cholangiopancreatography (ERCP)
  2. Endoscopic Retrograde Cholangiopancreatography (ERCP) with stent placement
  3. Surgery, such as:
    • Cholecystectomy
    • Choledochostomy
    • Choledochoduodenostomy (CDD)
    • Choledochojejunostomy

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