title: Catheter dislodgement of percutaneous transhepatic biliary drainage: identification of role of puncture sites and catheter sheath.
abstract: BACKGROUND
  To identify the appropriate puncture points in the bile duct to avoid catheter dislodgement.
  
  
  METHODS
  Percutaneous transhepatic biliary drainage catheters (n = 300) were placed in 242 patients. The frequency of dislodgement (complete dislodgement or bending of the catheter) was prospectively investigated. The puncture site of the bile duct was classified on the ultrasonographic findings as follows: Main-B3, main branch of the lateral inferior segment; peripheral-B3, peripheral branch of the lateral inferior segment; B2, lateral superior segment; left hepatic duct, proximal portion of the left hepatic duct; B8, anterior superior segment; B5, anterior inferior segment; B5 + 8, main bile duct of the anterior segment; B6, bile duct of posterior inferior segment; and right hepatic duct, proximal portion of the right hepatic duct.
  
  
  RESULTS
  When a catheter without an outer sheath was used, catheter dislodgement in peripheral-B3 (2/11, 18%) was more common than in main-B3 (0/32, 0%; p < 0.05). In B5, catheter dislodgement (6/12, 50%) was more frequent than in B8 (3/20, 15%; p < 0.05) and in B6 (0/14, 0%; p < 0.005). When a catheter with an outer sheath was used, catheter dislodgement (2/207, 1%) was rare.
  
  
  CONCLUSIONS
  Drainage from B5 and peripheral-B3 is associated with a high risk of dislodgement of the catheter. A catheter with an outer sheath was useful to prevent catheter dislodgement.
authors.affiliation: Department of Gastroenterology, Jichi Medical School, Yakushiji, Tochigi 329-0498, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Tamada
authors.forename: T
authors.initials: T
authors.lastname: Tomiyama
authors.forename: S
authors.initials: S
authors.lastname: Wada
authors.forename: A
authors.initials: A
authors.lastname: Ohashi
authors.forename: Y
authors.initials: Y
authors.lastname: Satoh
authors.forename: T
authors.initials: T
authors.lastname: Higashizawa
authors.forename: T
authors.initials: T
authors.lastname: Miyata
authors.forename: K
authors.initials: K
authors.lastname: Ido
authors.forename: K
authors.initials: K
authors.lastname: Sugano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000000981:diagnostic imaging; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002758:Cholangiography; D004322:Drainage / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011677:Punctures / Q000379:methods; D018084:Ultrasonography, Interventional