Transjugular liver biopsy

A liver biopsy is a procedure in which small pieces of liver tissue are extracted and sent to a laboratory for evaluation. Usually the biopsy is performed by inserting a needle through the skin into the liver; this can sometimes result in bleeding from the liver into the abdomen.

A child with increased risk of bleeding or with a large amount of fluid in the abdomen will require a different type of biopsy, called a transjugular liver biopsy. During this procedure we thread a catheter (a thin tube) through the internal jugular vein in the neck and into the liver. This way if the liver bleeds, the blood goes into a vein instead of the abdomen.

Procedure

Using ultrasound and live X-ray (fluoroscopy) for guidance, the doctor will insert the catheter into the vein in the neck and guide it into the primary vein in the liver. A tiny needle will be inserted through the catheter and into the liver to obtain pieces of tissue. (Your child will be protected by an X-ray shield during the procedure.) The procedure should take approximately one hour to complete.

A bandage will be placed where the needle was inserted. Be sure to keep the bandage dry for 24 hours.

Anesthesia

Patients receive either IV sedation or general anesthesia and are asleep for this procedure.

Pain

We might have to place an IV for sedation. Your child will feel a needle prick when we inject local numbing medicine before we insert the IV.

Risks

This procedure is considered low-risk. However, potential complications include:

• bleeding
• infection
• puncture of adjacent structures (such as other veins or arteries)
• air embolism (air bubbles in the bloodstream; rarely occurs)

After the Procedure

Your child may experience some discomfort and will need to stay in bed for approximately four hours in the recovery area. After four hours, a complete blood count (CBC) will be taken to monitor your child for any bleeding. If the test is normal, children who are outpatients will be able to go home.

Leave the bandage on your child’s neck for 24 hours. After 24 hours, you may remove the gauze and the clear bandage but do not remove the white Steri-Strips®. If the Steri-Strips have not fallen off after seven days, you may remove them.

Bathing

Your child should not shower or take a bath for 24 hours. After that, your child may have a sponge bath or a regular bath as long as you keep the injection site dry. Once the Steri-Strips fall off, regular baths and showers are fine.

Activity Restrictions

Your child should rest on the day of the procedure. The next day, your child can return to light activities but should avoid strenuous activity and contact sports for one week.