Catheter dislodgement of percutaneous transhepatic biliary drainage: identification of role of puncture sites and catheter sheath

Background: To identify the appropriate puncture points in the bile duct to avoid catheter dislodgement. Methods: Percutaneous transhepatic biliary drainage catheters (n = 300) wer e placed in 242 patients. The frequency of dislodgement (complete dislodgem ent or bending of the catheter) was prospectively investigated. The punctur e site of the bile duct was classified on the ultrasonographic findings as follows: Main-B3, main branch of the lateral inferior segment; peripheral-B 3, 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 dislodg ement in peripheral-B3 (2/11, 18%) was more common than in main-B3 (0/32, 0 %; p < 0.05). In B5, cacheter dislodgement (6/12, 50%) was more frequent th an in B8 (3/20, 15%; p < 0.05) and in B6 (0/14, 0%; p < 0.005). When a cath eter with an outer sheath was used, catheter dislodgement (2/207, 1%) was r are. Conclusion: Drainage from B5 and peripheral-B3 is associated with a high ri sk of dislodgement of the catheter. A catheter with an outer sheath was use ful to prevent catheter dislodgement.