Transjugular Liver Biopsy Periprocedural Care

Updated: Jan 24, 2020
  • Author: Sapna Puppala, MBBS, MRCS, MRCS(Edin), FRCS(Edin), FRCR, CBCCT, EBIR; Chief Editor: Justin A Siegal, MD  more...
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Periprocedural Care

Preprocedural Planning

Obtain informed consent. Confirm that there is no contrast allergy and that the platelet count is higher than 50,000/μL. Patient should have nothing by mouth for 4-6 hours prior to the procedure.

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Equipment

The biopsy kit commonly used is manufactured by Cook Medical (Bloomington, IN). The kit contains the following materials, which can be assembled if the kit is unavailable:

  • Long (49 cm) sheath, 7 French (see the first image below)
  • Angled metal sheath stiffener (see the second image below)
  • Straight catheter, 5 French
  • Cutting biopsy needle, 60 cm (see the third image below)
  • Multipurpose catheter, 5 French
  • Guide wire
Transjugular liver biopsy. 7-French sheath (outer Transjugular liver biopsy. 7-French sheath (outer blue) with inner straight catheter (black).
Transjugular liver biopsy. Sheath with metal stiff Transjugular liver biopsy. Sheath with metal stiffener. Note metal guide at proximal end.
Transjugular liver biopsy. Biopsy needle. Transjugular liver biopsy. Biopsy needle.

Other equipment needed includes the following:

  • Ultrasound machine with linear-array probe
  • Fluoroscopy
  • Skin disinfectant (eg, chlorhexidine, povidone-iodine solution)
  • Heparinized saline (1000 U heparin in 1000 mL of 0.9% NaCl)
  • Basic angiography kit, including puncture needle
  • Sheath, 5 French
  • Cobra-2 catheter
  • Hydrophilic-coated guide wire (Terumo, Somerset, NJ)
  • 1-cm floppy-tip Amplatz guide wires
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Patient Preparation

Anesthesia

In adults, local anesthesia (eg, lidocaine 1% 10 mL) is required for the jugular puncture site on the neck. (For more information, see Local Anesthetic Agents, Infiltrative Administration.) In children, general anesthesia is usually required for this procedure.

Positioning

Position the patient supine with the patient’s head turned away from the jugular puncture site.

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