Advice after your nerve block for surgery
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Introduction
We have been advised by your hospital consultant that you need to have a liver biopsy via the jugular vein in the neck. These are done in the radiology department by Interventional Radiologist (doctor specialising in medical imaging) by guiding a needle into the body under ultrasound and fluoroscopic control to accessing a vessel to be able to guide wires and small plastic tubes (catheters) into the correct location. The procedures will be performed by a radiologist who will be assisted by radiographers and radiology nurses.
This information tells you about having the procedure, what is involved, and what the possible risks are. This is not intended to replace the discussion between you and your consultant, but may act as a starting point for discussion. If after reading this information you still have concerns or require further explanation, please contact us using the telephone number on your appointment letter, or ask the ward staff.
What is a Transjugular Liver biopsy?
A liver biopsy is a procedure that involves taking a tiny specimen of the liver for examination under a microscope. In most cases, a liver biopsy is taken through the skin by passing a fine needle through into the liver. A transjugular liver biopsy is an alternative way of obtaining the liver specimen by passing the needle into the vein in the neck (jugular vein) and then through the liver veins to obtain a sample of the liver. This method is used in patients who have abnormal clotting of the blood or fluid collecting within abdomen. The technique is used to reduce the risk of bleeding after the biopsy as any bleeding will go back into the vein you have taken the biopsy from and so back into your own body.
Before your appointment
Please let us know if:
- you are taking any medication which impair the bloods ability to clot (anticoagulation or blood thinning drugs) e.g. Warfarin or clopidigrel, or, if you are aware that you may have bleeding problems. The radiologist who will be performing your examination can be notified and may need to discuss this with you and your hospital consultant before your appointment can be confirmed as the medication may need to be stopped or changed before the procedure. The Interventional nursing team can be informed on 0300 613 2161 (Frimley) or 0300 615 3544 (Wexham).
Please also let us know if:
- you have limited mobility and will require assistance to get on and off the scanner.
- you will need an interpreter. We are not able to use family members or friends to interpret.
- there is any possibility that you may be pregnant. All patients from 12-55 years of age (regardless of gender) who will undergo a Radiology procedure will be asked about the possibility of them being pregnant
- you are diabetic - please note that you are required to starve before the examination. You may be given an early morning appointment or alternative medication will be given on the ward.
In order to make your appointment run more smoothly, please let us know if any of these apply, in advance, by calling our bookings team (contact details are displayed on the main Radiology page).
Please review the CT contrast safety questionnaire enclosed in this letter and fill this in before your appointment. This can be completed on paper and where indicated this can also be completed online.
Eating and Drinking
You should have nothing to eat 6 hours prior to the time of your procedure. You can continue to drink clear fluids (water) up to 2 hours prior to the procedure but then nothing should be consumed.
What to bring with you
You will usually be admitted for the procedure as a day case. Occasionally it is necessary for patients to stay overnight in hospital after the biopsy. For this reason we advise that you prepare an overnight bag and bring this with you. You may wish to bring your own dressing gown, slippers and reading material.
Please bring with you to your appointment any sprays or inhalers that you are taking. Please bring a list of any regular medications you are taking
During the procedure
Referral and consent
You will be asked to sign a consent form confirming that you understand the procedure and are aware of the risks and benefits involved. Where practical this is usually done on the ward, before you come to the Radiology Department or in an outpatient clinic environment before your admission to hospital for the procedure.
The procedures are normally done as a planned procedure and you should have plenty of time to discuss the situation with your doctor or the nurse specialist looking after you before you sign the consent form. When you arrive for the procedure you will also discuss the procedure with the radiologist who will be performing the procedure who will again sign the consent form with you.
If after discussion with your hospital doctor or radiologist, you do not want the procedure carried out, then you can decide against it. If the radiologist feels that your condition has changed or that your symptoms do not indicate such a procedure is necessary then they will explain this to you and they will communicate with the referring doctor who will review your situation as soon as possible. At all times the radiologist and referring doctor will be acting in your best interests.
Procedure
The procedure will be explained to you by the radiologist. You will be able to ask any further questions that you may have.
You will be asked to lie on the examination table. It is important that you stay very still until the procedure is over. If you are uncomfortable please let the doctor know. You may need a cannula (small tube) inserted into a vein in your arm to allow access for fluids and for administering medication.
The radiologist will keep everything as sterile as possible, and will wear a theatre gown and operating gloves. The skin near the point of insertion, usually the groin, will be thoroughly cleaned with antiseptic, and then most of the rest of your body covered with a theatre towel.
The skin and deeper tissues over the vein in the neck will be anaesthetised with local
anaesthetic, and then a needle will be inserted into this vein. Once the radiologist is satisfied that this is correctly positioned, a guide wire is placed through the needle, and into the vein.
Then the needle is withdrawn allowing a fine, plastic tube (a catheter) to be placed over the wire and into this vein.
The radiologist will use X-ray fluoroscopy to make sure that the catheter and the wire are then moved into the veins in the liver. A special x-ray dye, called contrast medium, is injected down the catheter into these vessels, and this may give you a warm feeling.
Once in the correct position the biopsy will be taken and/or measurements of the pressure in the vein will be done.
At the end of the procedure, the catheter is withdrawn and the radiologist then presses on the groin to stop any bleeding.
After the procedure
Once you have returned to your ward, nurses will carry out close and regular observations, such as taking your pulse, blood pressure and temperature, to make sure that there are no problems. You should tell the nurses if you feel worsening pain or a rise in your body temperature. You should drink plenty of fluids and eat normally
If you have any problems after the procedure please speak to the staff on the ward or contact your GP or emergency doctor if problems occur when you have returned home
Will it hurt?
When the local anaesthetic is injected it will sting initially, but this soon passes off, and the area should then feel numb with only the sensation of pushing remaining.
How long does it take?
As an approximate guide, expect to be in the Radiology Department for about 45 minutes to one hour. However much of this time is taken up by preparation rather than the procedure itself. You will normally be expected to rest on the ward for at least four hours after the procedure.
Risks
As with any procedure or operation, complications are possible. The possibility of these occurring will vary for each patient and the possibility of these happening to you will be discussed with you, before you sign the consent form.
- Bleeding: Any intervention on a blood vessel carries a risk of bleeding. There may be a small bruise around the site where the needle has been inserted and this is quite normal. There is a chance that the bruise may become very large and uncomfortable, but this does not happen very often.
- Occasionally a diagnosis cannot be reached on the sample provided so the procedure may have to be repeated again to obtain a diagnostic sample.
- X-rays used in the procedure are a type of radiation. We are all exposed to natural background radiation every day from the sun, food we eat, and the ground. Exposure to medical X-rays carries a small additional risk, but your doctor feels that this risk is outweighed by the benefits of having the procedure and the amount of radiation you will receive is kept to as low as reasonably possible
Contact us
If you have any queries relating to this information, please contact the Radiology service.
About this information
Service:
Radiology
Reference:
PILS-IR.26
Approval date:
2 October 2024
Review date:
2 October 2027
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.