Biliary Stenting Periprocedural Care

Updated: Nov 18, 2015
  • Author: Philip L Johnson, MD; Chief Editor: Kyung J Cho, MD, FACR, FSIR  more...
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Periprocedural Care

Equipment

A dedicated procedure room with a C-arm fluoroscopy unit equipped with pulsed fluoroscopy, beam collimation, and lead shields to limit the radiation dose is essential. Radiation monitoring badges should be worn at all times. The procedure room should also be furnished with modern anesthesiology, electrocardiography, and oxygen saturation monitoring equipment.

The procedure is performed in a sterile environment, and requirements include hat, mask, sterile gowns, sterile gloves, general sterile procedure pack, and sterile towels. The procedures are performed using nonionic water-soluble contrast agents. Procedural equipment includes devices required for initial percutaneous biliary access and biliary stent placement.

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Patient Preparation

Anesthesia

Percutaneous biliary procedures can be associated with significant pain, and there is wide variation in patient tolerance to pain and ability to cooperate. Therefore, a carefully considered plan for analgesia and sedation is mandatory. The patient is carefully evaluated for medical comorbidities, NPO (nil per os) status, prior history of anesthesia, tolerance to prior procedures, and the complexity of the planned procedure.

The American Society of Anesthesiologists (ASA) physical classification system is a useful and simple tool for stratifying patient risk. For most patients, conscious sedation is the most appropriate level of analgesia and sedation, balancing safety and comfort. During conscious sedation, patients are able to maintain purposeful response to verbal and tactile stimulation, ventilate spontaneously, and maintain cardiovascular function. A combination of a fast-acting opioid (eg, fentanyl) for pain and a fast-acting benzodiazepine (eg, midazolam) for anxiolysis is typical. It is important to understand the synergistic effect these drugs have when used in combination and to realize the wide variation in patient sensitivity.

Careful titration and monitoring are essential. Appropriately trained personnel, hemodynamic and oxygen monitoring equipment, and immediate access to drugs and resuscitation equipment are imperative.

Positioning

Percutaneous biliary procedures are performed with the patient in a supine position. The use of a rotating C-arm conveniently obviates the need to rotate the patient for additional oblique views.

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