Patient Information Leaflet

Transjugular Liver Biopsy

Transjugular liver biopsy

1) What is a Transjugular liver biopsy?

A transjugular liver biopsy is where a sample of tissue is taken from your liver. This is done by placing a catheter (hollow tube) and needle into your jugular vein( vein in the neck) which is guided into your liver. The sample is taken and sent to pathology for testing. Iodinated ‘Contrast’ (once called x-ray dye) is used to map your veins so the doctor can place the catheter into the hepatic vein,This procedure is performed in radiology department with guidance from imaging machines such as ultrasound and x-ray. This procedure is done by an interventional radiologist

2) When is the transjugular route preferred?

Although most liver biopsies can be done by percutaneous route under ultrasound guidance, transjugular route is recommended in certain situations

  • Ascites
  • Coagulopathy

Tips for your Safety

  • Wash hands before injecting, do not share needles
  • Cover any open cuts or wounds
  • Use of barriers and condoms will help reduce risk of sexual transmission
  • During pregnancy it is important to test for hepatitis B and C infection due to risk of transmission of infection from mother to baby(more with Hepatitis B compared to C)
  • Do not share razors, toothbrushes, nail clippers or pierced earrings.
  • Make sure tattoo and piercing equipment package is opened up in front of you

3) Is any anaesthetic needed?

This procedure will require an injection of local anaesthetic and the use of a sedation or general anaesthetic. Sedation is the use of drugs that makes you feel very relaxed during procedure that may be otherwise unpleasant or painful. You may have little or no memeory about what has occurred during the procedure. You need to be able to fully co-operate at times by holding your breath when instructed by the doctor. Sedation is generally very safe but has a small risk of side-effects and complications.

4) Preparation for the procedure

  • You should be fasting for 6 hrs prior to procedure This is to make sure your stomach is empty so that if you vomit during the procedure there will be nothing to go into your lungs.
  • Please tell the staff if you are or suspect you might be pregnant as it is not safe to do this during pregnancy
  • If you take Aspirin, Warfarin, Clopidogrel (Plavix and Iscover) or Dipyridamole (Persantin and Asasantin) or any other drug that is used to thinyour blood ask your doctor/health
  • practitioner if you should stop taking it before the procedure as it may affect your blood clotting.
  • List or bring all your prescribed drugs, those drugs you buy over the counter, herbal remedies and supplements.

5) During the procedure

A fine needle (IV cannula) will be inserted into a vein in your arm. The Radiologist (x-ray doctor) will inject local anaesthetic into the skin on your neck. A small cut will be made. Using ultrasound as a guide the Radiologist will insert a needle through the cut and into your jugular vein. You must remain as still as possible. At times, you may be asked to hold your breath.

The catheter will be inserted into the vein and the needle removed. Contrast will be injected as x-ray pictures are taken.

Once the catheter is in place, a long needle is then passed through the catheter to obtain the tissue sample. It is not unusual for this step to be repeated. At the end of the procedure, the needle and catheter will be removed and pressure will be applied over the area where the catheter went into your skin (puncture site). A dressing will be applied

6) After the procedure

The recovery time varies depending on the sedation that has been given. It varies between 4 hours to 6 hours. The IV cannula will be removed after you have recovered. Staff will squareuss with you what level of activity is suitable after your procedure.

7) What are the risks of this specific procedure?

The risks and complications with this procedure can include but are not limited to the following.

Common risks and complications include:

  • Minor pain, bruising and/or infection from the IV cannula. This may require treatment with antibiotics.
  • Pain or discomfort at the puncture site. This may require medication.
  • Bleeding or bruising may occur. This is more common if you take Aspirin, Warfarin, Clopidogrel (Plavix and Iscover) or Dipyridamole (Persantin and Asasantin).
  • Failure of local anaesthetic which may require a further injection of anaesthetic or a different method of anaesthesia may be used.
  • Nerve damage, is usually temporary, and should get better over a period of time.
  • Permanent nerve damage is rare.
  • Pain, this may require medication to treat.

Less common risks and complications include:

  • Infection, requiring antibiotics and further treatment.
  • Damage to surrounding structures such as blood vessels, organs and muscles, requiring further treatment.
  • Excessive bleeding from the liver. This may require other treatment and/or corrective surgery.
  • An allergy to injected drugs, requiring further treatment.
  • The biopsy procedure may not obtain enough tissue and may need to be repeated at a later date.
  • A fast or irregular heart beat. This usually resolves on its own or may need further treatment.
  • The procedure may not be possible due to medical and/or technical reasons.

Rare risks and complications include:

  • An increased lifetime cancer risk due to the exposure to x-rays.
  • Seizures and/or cardiac arrest due to local anaesthetic toxicity.
  • Death as a result of this procedure is very rare.

If sedation is given extra risks include:

  • faintness or dizziness, especially when you start to move around
  • fall in blood pressure
  • nausea and vomiting
  • weakness
  • an existing medical condition getting worse
  • heart and lung problems such as heart attack or vomit in the lungs causing pneumonia.
  • This may require emergency treatment stroke resulting in brain damage.

8) What are the safety issues when you leave the hospital?

If you were sedated, this will affect your judgment for about 24 hours. For your own safety:

  • Do NOT drive any type of car, bike or other vehicle.
  • Do NOT operate machinery including cooking implements.
  • Do NOT make important decisions or sign a legal document.
  • Do NOT drink alcohol, take other mind-altering substances, or smoke. They may react with the anaesthetic drugs.
  • Have an adult with you on the first night after your procedure. Go to your nearest
  • Emergency Department or GP if you become unwell or have;
  • pain, unrelieved by simple pain killers
  • continuous bleeding or swelling at the puncture site
  • redness or inflammation at the puncture site
  • fever
  • other warning signs the doctor may have asked you to be aware of.