HEPATIC VENOGRAPHY

It is a radiographic examination of Hepatic veins in which contrast is injected into the IVC via femoral vein to visualize the abnormalities of the hepatic veins.

Indications 

• Obstruction in hepatic veins
• To detects the abnormalities in Hepatic vein
• To evaluate the patency of hepatic vein
• Formation of a blood clot within the hepatic veins 

Contraindications

• Hypersensitivity to contrast
• Blood clotting disorder
• Suspected pregnancy
• Impaired renal function 
• Severe phlebitis
• Severe hepatic dysfunction

Equipment

• Fluoroscopy unit with tilting table 
• Catheter 5F
• Automatic pressure injector 
• Contrast
• Normal Saline
• Antiseptic solution
• Femoral vein access needle
• Guidewire
• Sheath
• Gauze 

Patient  preparation

• The patient should not eat or drink after midnight.
• Patient KFT reports must be reviewed prior to the examination.
• Ask patient to stop taking anticoagulant before the exam.
• Explain the procedure to the patient.
• Ask the patient to remove clothing and wear hospital gown. 

Procedure

• Place the patient in supine position on fluoroscopy table.
• An intravenous line is inserted into the patient arm and sedative medication is given through line to make patient relax.
• The groin area of the patient must be cleaned with the antiseptic.
• The local anaesthesia is given at the insertion site of the groin.
• After numbing the groin area , a vascular access needle is inserted into the femoral vein by using the seldinger technique.
• When the blood comes out from the needle a flexible guidewire is inserted through the needle. After placing the guidewire the needle is removed then the sheath is placed over the guidewire under the fluoroscopic guidance.
• The catheter with side holes is inserted into the femoral vein through the sheath.
• The catheter is smoothly advance through the femoral vein and position inside the iliac vein under the fluoroscopic guidance.
• The contrast media is injected at the rate of 20ml per second for a total of 40ml into the vein through the catheter.
• Ask the patient to perform valsalva maneuver for prolonging filling of contrast media in inferior vena cava then the rapid films are taken at the rate of 1 film per second of the abdomen region in AP, oblique positions.
• After completion of examination the catheter and the sheath is removed and the dressing is applied on the puncture site of the foot.

Aftercare

• Keep the patient under observation BP, heart rate , injected sites swelling and other vital sign should be the monitored.
• Plenty of liquid diet is given to the patient to flush out the contrast media from the body.

Interpretation

• If the venogram shows blood clots or blockage in the veins, the special medicine may be given to dissolve the clot or the ballon angioplasty may be performed.
• To widen the vessels and improve blood flow during the angioplasty a metal stent may be placed by the surgeons.

Submitted by-

Divya Jha