Korean 환자교육 방사선 / 영상서비스 경정맥간조직검사귀하의시술소개 이용지는경정맥경유간생검이무엇인지그리고이시술을받을때겪는내용에관해설명합니다 간생검이란무엇인가? 간생검을할때, 의사는간에서작은크기의조직시료를제거합니다. 이조직을실험실에서연구하고검사합니다. 왜간생검이필요한가? 귀하의혈액검사가귀하에게만성간질환이있을수있는것으로나왔습니다. 간생검은이질병에관한상세한내용과귀하의간에발생한손상의정도를의사에게알려줍니다. 만약귀하가이식환자라면, 간생검은귀하가규칙적으로받는선별검사의한가지입니다. 이생검은의사가비정상적인간검사의원인이나거부현상의존재여부를알아내는데도움이됩니다. 간생검은어떻게검사하는가? 2 종류의간생검이있습니다 : 경피 ( 피부를통한 ) 간생검및경정맥경유 ( 경정맥을통한 ) 간생검. 경피간생검 간조직의시료를얻는가장보편적인방법은경피간생검입니다. 이시술의절차 : 의사가가슴이나복부의피부를통해간으로작은주사바늘을삽입합니다. 주사바늘을통해간조직의작은 벌레모양의 부분이제거됩니다. 경피간생검은출혈문제가있는사람의경우문제를야기할수있습니다. 간질환이있는많은사람들은출혈문제가있기때문에, 의사가경정맥경유간생검을받도록조언할것입니다.
페이지 2 방사선 / 영상서비스경정맥간조직검사 경정맥경유간생검 경정맥경유간생검은흔히혈액응고의문제가있거나복부에액체가많은사람에게권장됩니다. 이검사는이러한유형의시술전문의인중재적방사선전문가가수행합니다. 경정맥경유간생검의절차 : 의사가작은관을경정맥 ( 목부위 ) 에삽입합니다. 엑스레이는간의커다란정맥으로관을인도하여삽입하는데도움이됩니다. 작은주사바늘을관을통해간안으로삽입합니다. 주사바늘을이용하여 2, 3 개의작은조직시료를제거합니다. 이엑스레이사진은경정맥경유간생검을보여줍니다. 회색윤곽의영역이간입니다. 검은선은경정맥을통해서커다란간정맥으로유도된관입니다. 경정맥경유간생검시술과정에서출혈이있다면, 그피는대부분혈류밖으로나가지않고정맥안으로직행합니다. 이에따른위험이있는가? 모든침습적의료시술에는어떠한위험이따릅니다. 하지만 5 퍼센트미만의사람들 (100 명가운데 5 명미만 ) 은경정맥경유간생검이후문제를경험합니다. 중요한관심사는복부로출혈되는것입니다. 대부분의경우이러한출혈은생명을위협하지않습니다. 귀하의의사는귀하의위험에관해설명해줄것입니다. 질문과염려되는모든내용에대해설명을듣도록하십시오. 시술전 외래환자의경우, 담당간호사가귀하의시술전날오후에연락합니다. 시술이월요일에있다면, 간호사는전주의금요일에전화할것입니다. 이간호사는최종설명을제공하며모든질문에답해줍니다.
페이지 3 방사선 / 영상서비스경정맥간조직검사 영어에미숙하여시술에관련된설명이나내용을이해하지못한다면, 저희에게가능한한빨리알리십시오. 저희가병원통역사를연결하여도와드립니다. 귀하의가족이나친구는통역할수없습니다. 대부분시술전 14 일동안에혈액검사를받아야합니다. 저희는귀하가시술을위해도착한후에이검사를할수있습니다. 만약그전에혈액샘플이필요하다면알려드릴것입니다. 만약조영제 ( 엑스레이염료 ) 에대한알러지나부작용이있다면, 담당간호사에게알리십시오. 전화번호는이용지의마지막페이지에나와있습니다. 알러지가있다면시술전에투약이필요할수있습니다. 만약피를묽게하는약 ( 쿠마딘, 로베녹스, 프라그민, 플라빅스등 ) 을복용한다면, 시술전 3 일에서 9 일동안복용을중단해야할수있습니다. 이에대한지시를받게됩니다. 만약당뇨병이있어서인슐린이나메트포르민 ( 글루코파지 ) 을사용하고있다면, 생검당일에사용의중단이나용량조절에관한지시를받게됩니다. 진정 생검을받을때, 정맥을통하여진정제 ( 발륨이나모르핀과유사 ) 를투여받게됩니다. 이러한약은졸리게하고편안하게해주며불편감을덜어줍니다. 그러나깨어있게됩니다. 이것을얕은진정이라부릅니다. 시술이끝난후얼마동안은계속졸립니다. 사람에따라서얕은진정이안전하기않을수있습니다. 자신이이에해당한다면, 마취 ( 시술동안잠을자게하는약 ) 가필요합니다. 다음에해당되면저희에게즉시알리십시오 : - 과거에기본적인시술을위하여마취가필요했던경우 - 수면무호흡혹은만성호흡문제가있는경우 ( 잘때 CPAP 혹은 BiPAP 을사용했을수있음 ) - 마약성진통제를높은용량으로사용하는경우 - 심장, 폐또는신장질환이심한경우 - 허리나호흡문제때문에약 1 시간동안누워있을수없는경우 - 의료시술동안누워있는것이어려운경우 - 체중이 300 파운드 (136 킬로그램 ) 이상인경우
페이지 4 방사선 / 영상서비스경정맥간조직검사 시술전날 진정에대하여준비하려면, 다음설명을잘따르십시오 : 시술전날에는평상시와같이식사할수있습니다. 시술하기 6 시간전부터는맑은액체 ( 물, 스프라이트, 크랜베리주스, 약한차같이투명한액체 ) 만을드실수있습니다. 시술하기 2 시간전부터는 : - 아무것도드시지마십시오. - 약을복용해야하는경우, 물한모금만드십시오. - 비타민이나기타건강보조약품은들지마십시오. 빈속이아플수있습니다. 책임있는성인이귀하를집까지데려가서그날같이있어야합니다. 귀하스스로운전하거나버스, 택시, 승합차를타서는안됩니다. 시술당일 시술당일에도평상시복용하는약을모두드십시오. 의사나간호사의다른지시가없는한약을거르지마십시오. 복용하는약의목록을지참하십시오. 병원에서하루대부분을보낼계획을하십시오. 만약시술시작이지연된다면, 기대치않거나응급상황이있는다른사람들의치료를해야하기때문일것입니다. 이러한경우기다려주시면고맙겠습니다. 별도의지시가없는한, 워싱턴대학메디칼센터의 3 층 ( 메인층 ) 에있는입원창구에체크인하십시오. 입원창구는로비에있는안내데스크의뒤쪽오른편에있습니다. 간호조무사가착용할병원가운과소지품을넣을백을제공합니다. 화장실은언제나사용할수있습니다. 직원이귀하를시술전위치로데려갈것입니다. 그곳에서간호사는건강평가를실시하게됩니다. 가족이나친구는이곳에같이있을수있습니다. 정맥투여가시작될것입니다. 정맥투여를통해수액과약이투여됩니다. 중재적방사선전문의가시술에관해설명한다음, 아직승낙서에서명을하지않으셨다면서명을요청하게됩니다. 이때질문을할수있습니다.
페이지 5 방사선 / 영상서비스경정맥간조직검사 시술내용 간호사가귀하를방사선실로데려갑니다. 이간호사는시술동안귀하와함께하게됩니다. 의사가엑스레이로귀하의신체를볼수있도록귀하는평평한테이블에눕게됩니다. 심박율의측정을위하여귀하의신체에와이어가배치됩니다. 팔에는커프가착용됩니다. 이커프는때때로팽창하여혈압을체크하게됩니다. 방사선기술자가특수비누로써귀하의목부위피부를세척합니다. 만약알러지가있다면이사람에게알리십시오. 의료진전원은귀하의이름을확인할것이며다음절차를설명할것입니다. 이는귀하의안전을위한것입니다. 다음, 귀하의간호사가귀하에게졸리고편안하고해주는약을준다음시술이시작됩니다. 필요하다면통역자가같은방에있거나인터콤을통하여귀하의말을듣고통역합니다. 국소마취 ( 마취약 ) 을귀하목의피부에바르게됩니다. 마취제는약 5 에서 10 초동안따끔거립니다. 다음그부위의감각이없어지고더이상날카로운통증을느끼지않게됩니다. 카테터를경정맥에삽입한다음간정맥으로유도합니다. 다음에는조영제 ( 엑스레이염료 ) 를혈관으로넣습니다. 카테터가올바른위치에있게되면, 특수한바늘을카테터안으로넣어간의시료를수집합니다. 이때목부위에압박감과간에약간의통증을느끼는것은정상입니다. 2-3 개의시료를수집한다음카테터를제거합니다. 출혈방지를위하여카테터를삽입한목부위를몇분동안눌러줍니다. 시술후 외래환자는병원의단기체류장소로이동합니다. 그곳에서는다른간호사가약 4 시간동안귀하를관찰합니다. 이제는먹고마실수있으며가족의방문이가능합니다. 완전히깨어나서식사와화장실사용이가능하고걸을수있을때, 집에갈수있습니다. 이시술과관련된문제는드뭅니다. 만약문제가발생하면, 귀하에대한관찰과치료를위하여귀하를병원에더있도록할수도있습니다. 병원을떠나기전에, 귀하의간호사는귀하가할수있는활동과절개부위의간호방법및다른중요한지시사항을설명할것입니다.
페이지 6 방사선 / 영상서비스경정맥간조직검사 질문이있으십니까? 귀하의질문은중요합니다. 질문이나염려하는것이있으시면의사나의료제공자에게연락하십시오. UWMC 의료진또한도와드릴수있습니다. 방사선 / 영상서비스 : 206-598-6200 집에돌아간후 돌아간날에는집에서편히쉬십시오. 가족이나친구또는간병인의도움을받아야합니다. 졸리거나짧은기간동안기억력상실을경험할수있습니다. 24시간동안은다음을하지마십시오 : - 차운전이나기계작동 - 음주 - 중요한개인적인결정을내리거나법적문서의서명 - 다른사람을돌보는책임 다음날부터는샤워나목욕을할수있습니다. 경정맥경유간생검후에는약간의통증이있습니다. 의사가아세트아미노펜 ( 타이레놀 ) 의복용을허가하면, 모든불편함을없애는데충분할것입니다. 만약의사가더심한통증이있을수있다고한다면, 보다강한진통제의처방을받게될것입니다. 식사를시작하는즉시평상시약의복용을계속하십시오. 의사가처방하거나승인한약만복용하십시오. 연락할때 다음이발생하면즉시저희에게전화하십시오 : 카테터를삽입한목부위의출혈 복부의통증 어지러움 연락할사람 중재적방사선과간호사조정관...206-598-6897 시술예약...206-598-6209 업무시간이후 ( 오후 5 시부터오전 7 시까지 ) 그리고주말과휴일당직중재적방사선과휄로우...206-598-6190 응급상황의경우 가장가까운응급실로직접가거나 9-1-1 에연락하십시오. 저희의료진과연락을위하여기다리지마십시오. Box 357115 1959 N.E. Pacific St. Seattle, WA 98195 206-598-6200 University of Washington Medical Center Korean Published: 03/2006, 06/2006, 02/2012 Clinician Review: 02/2012 Reprints on Health Online: https://healthonline.washington.edu
Patient Education Transjugular Liver Biopsy About your procedure This handout explains what a transjugular liver biopsy is and what to expect when you have this procedure. What is a liver biopsy? In a liver biopsy, your doctor takes a small sample of tissue from your liver. This tissue is studied and tested in the lab. Why do I need a liver biopsy? Your blood tests show that you may have chronic liver disease. A liver biopsy will tell your doctors more about this disease and how much damage has been done to your liver. If you are a transplant patient, a liver biopsy is one of your regular screening tests. The biopsy will help your doctors find the cause of abnormal liver tests or to see if rejection is present. How is a liver biopsy done? There are 2 types of liver biopsy: a percutaneous (through the skin) liver biopsy and a transjugular (through the jugular vein) liver biopsy. Percutaneous Liver Biopsy The most common way to get a sample of liver tissue is with a percutaneous liver biopsy. During this procedure: Your doctor inserts a small needle into your liver through the skin of your chest or abdomen. The needle removes a small worm-like segment of your liver tissue. A percutaneous liver biopsy can cause problems for people who have bleeding problems. Because many people with liver disease have bleeding problems, your doctor is advising you to have a transjugular liver biopsy.
Page 2 A transjugular liver biopsy is often advised for people who have a problem with blood clotting or a large amount of fluid in their abdomen. It is done by an interventional radiologist, a doctor who specializes in this type of procedure. During transjugular liver biopsy: Your doctor will insert a small tube into your jugular (neck) vein. X-rays will help guide the tube into a large vein in your liver. A small needle is inserted through the tube and into your liver. The needle removes 2 or 3 small samples of tissue. This X-ray picture shows a transjugular liver biopsy. The area outlined in gray is the liver. The dark line is the tube that was inserted through the jugular vein and guided into the large liver vein. If there is bleeding during a transjugular liver biopsy, the blood most often goes directly into the vein, not outside of the bloodstream. Are there risks involved? All invasive medical procedures involve some risk. But, less than 5% of people (less than 5 out of 100) have problems after transjugular liver biopsy. The main concern is bleeding into your abdomen. Most times, this bleeding is not life-threatening. Your doctor will talk with you about your risks. Please make sure all of your questions and concerns are addressed. Before Your Procedure If you are an outpatient, a nurse coordinator will call you the afternoon before your procedure. If your procedure is on a Monday, the nurse will call you the Friday before. The nurse will give you final instructions and answer any questions you have.
Page 3 If you do not understand English well enough to understand these instructions or the details of the procedure, tell us as soon as possible. We will arrange for a hospital interpreter to assist you. A family member or friend may not interpret for you. You most likely will need blood tests done within 14 days of your procedure. We may do this when you arrive for your procedure. We will tell you if we need a blood sample before that day. If you have a history of allergy or bad reaction to contrast (X-ray dye), please call our nurse coordinators at one of the phone numbers on the last page of this handout. You may need medicine for this allergy before the procedure. If you take any blood-thinning medicines (such as Coumadin, Lovenox, Fragmin, or Plavix), you may need to stop taking the medicine for 3 to 9 days before the procedure. You will receive instructions about this. If you have diabetes and take insulin or metformin (Glucophage), you will receive instructions about holding or adjusting your dose for the day of your biopsy. Sedation When you have your biopsy, you will be given a sedative medicine (similar to Valium and morphine) through your IV. This medicine will make you sleepy, help you relax, and lessen your discomfort. You will stay awake. This is called conscious sedation. You will still be sleepy for a while after the procedure. For some people, using conscious sedation is not safe. If this is true for you, you will need anesthesia (medicine to make you sleep during the procedure). Let us know right away if you: - Have needed anesthesia for basic procedures in the past - Have sleep apnea or chronic breathing problems (you might use a CPAP or BiPAP device while sleeping) - Use high doses of narcotic painkiller - Have severe heart, lung, or kidney disease - Cannot lie flat for about 1 hour because of back or breathing problems - Have a hard time lying still during medical procedures - Weigh more than 300 pounds (136 kilograms)
Page 4 Day Before Your Procedure To prepare for sedation, follow these instructions closely: The day before your procedure, you may eat as usual. Starting 6 hours before your procedure, you may only have clear liquids (liquid you can see through, such as water, Sprite, cranberry juice, or weak tea). Starting 2 hours before your procedure: - Take nothing at all by mouth. - If you must take medicines, take them with only a sip of water. - Do not take vitamins or other supplements. They can upset an empty stomach. You must have a responsible adult drive you home and stay with you the rest of the day. You may NOT drive yourself home or take a bus, taxi, or shuttle. On the Day of Your Procedure Take all of your other usual medicines on the day of the procedure. Do not skip them unless your doctor or nurse tells you to. Bring a list of all the medicines you take with you. Please plan to spend most of the day in the hospital. If there is a delay in getting your procedure started, it is usually because we need to treat other people with unexpected and urgent problems. Thank you for your patience if this occurs. Unless told otherwise, check in at Admitting on the 3rd (main) floor of University of Washington Medical Center. Admitting is to the right and behind the Information Desk in the lobby. A medical assistant will give you a hospital gown to put on and a bag for your belongings. You may use the restroom at that time. A staff member will take you to a pre-procedure area. There, a nurse will do a health assessment. Your family or friend can be with you there. An IV line will be started. You will be given fluids and medicines through the IV. An interventional radiology doctor will talk with you about the procedure and ask you to sign a consent form if that has not already been done. You will be able to ask questions at that time.
Page 5 Your Procedure The nurse will take you to the radiology suite. This nurse will be with you for the entire procedure. You will lie on a flat table that allows the doctor to see into your body with X-rays. Wires will be placed on your body to help us monitor your heart rate. You will have a cuff around your arm. It will inflate from time to time to check your blood pressure. A radiology technologist will clean your skin around your neck with a special soap. Tell this person if you have any allergies. The entire medical team will ask you to confirm your name and will tell you what we plan to do. This is for your safety. Then, your nurse will give you medicine to make you feel drowsy and relaxed before we begin. If needed, an interpreter will be in the room or will be able to talk with you and hear you through an intercom. A local anesthetic (numbing medicine) will be applied to the skin on your neck. The anesthetic burns for about 5 to 10 seconds. Then the area will be numb and you will not feel any sharp pain. The catheter is inserted into your jugular vein and guided to your liver veins. Contrast (X-ray dye) is then given into your blood vessel. When the catheter is in the correct spot, a special needle is threaded into the catheter and a liver sample is taken. It is normal to feel pressure in your neck and slight pain in your liver. About 2 or 3 tissue samples are taken and the catheter is removed. Pressure is held on your neck where the catheter was inserted for a few minutes to prevent bleeding. After Your Procedure If you are an outpatient, you will then go to a short-stay unit in the hospital. A different nurse will monitor you there for about 4 hours. You will be able to eat and drink, and your family may visit you. When you are fully awake and are able to eat, use the restroom, and walk, you will be able to go home. Problems with this procedure are rare. If they occur, we may need to keep you in the hospital so that we can monitor or treat you. Before you leave the hospital, your nurse will tell you what activities you can do, how to take care of your incision, and other important instructions.
Page 6 Questions? Your questions are important. Call your doctor or health care provider if you have questions or concerns. UWMC clinic staff are also available to help. Radiology/Imaging Services: 206-598-6200 When You Get Home Relax at home for the rest of the day. Make sure you have a family member, friend, or caregiver to help you. You may feel sleepy or have some short-term memory loss. For 24 hours, do not: - Drive a car or use machinery - Drink alcohol - Make important personal decisions or sign legal documents - Be responsible for the care of another person You may shower or bathe the next day. There is only minor pain after a transjugular liver biopsy. If your doctor says it is OK for you to take acetaminophen (Tylenol), this should ease any discomfort you have. If your doctor expects you to have more severe pain, you will receive a prescription for a stronger pain medicine. Resume taking your usual medicines as soon as you start to eat. Take only the medicines that your doctors prescribed or approved. When to Call Call us right away if you have: Bleeding in your neck where the catheter was inserted Abdominal pain Dizziness Who to Call Interventional Radiology nurse coordinator... 206-598-6897 Procedure Scheduling... 206-598-6209 After hours (between 5 p.m. and 7 a.m.), and on weekends and holidays Ask for the Interventional Radiology Fellow on call... 206-598-6190 If You Have an Emergency Go directly to the nearest Emergency Room or call 9-1-1. Do not wait to contact one of our staff. Box 357115 1959 N.E. Pacific St. Seattle, WA 98195 206-598-6200 University of Washington Medical Center Published: 03/2006, 06/2006, 02/2012 Clinician Review: 02/2012 Reprints on Health Online: http://healthonline.washington.edu