Transhepatic Biliary Catheterization: Procedure, Indications, and Post-Procedure Care

Procedure

Under imaging guidance (ultrasound/fluoroscopy), a needle is advanced through the liver parenchyma into a bile duct. Contrast confirms position. A guidewire is passed, then a catheter is advanced over the wire into the biliary tree. The catheter is secured externally to a drainage bag.

Indications

• Malignant or benign biliary obstruction (cholangiocarcinoma, pancreatic cancer, stones, strictures).
• Preoperative decompression before biliary surgery.
• Palliative drainage for unresectable disease.
• Access for stent placement, stone extraction, or biopsy.

Benefits

• Nonsurgical alternative to endoscopic (ERCP) or surgical bypass.
• Relieves jaundice, pruritus, cholangitis.
• Allows internalization (internal-external drain) or external drainage.

Post-Procedure Care

• Monitor output, electrolytes, liver function.
• Flush catheter per protocol to maintain patency.
• Watch for bile leak, hemorrhage, sepsis.
• Patient education on bag care and signs of complication.