From the Guidelines
Needle Size for TIPS Procedure
A 10-French (10F) needle is typically recommended for a Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure, as it provides a large enough lumen to accommodate the necessary guidewires and catheters while minimizing the risk of vascular damage and bleeding complications 1.
Procedure Considerations
The TIPS procedure is a complex intervention that requires careful planning and execution, considering factors such as patient anatomy, liver function, and the presence of any underlying vascular disease. The procedure typically involves the use of a combination of medications, including heparin for anticoagulation and lidocaine for local anesthesia. However, the choice of sedation is crucial, with general anaesthetic or propofol-based deep sedation being preferred over conscious sedation, especially for painful procedures like intrahepatic balloon dilatation 1.
Key Components and Considerations
- Needle size: A 10F needle is considered optimal for accessing the hepatic vein and creating the shunt.
- Sedation: General anaesthetic or propofol-based deep sedation is recommended.
- Patient preparation: Includes specialized scans, up-to-date biochemistry, haematology, and ECG, as well as hydration to facilitate central venous puncture and minimize the risk of contrast nephropathy.
- Procedure monitoring: Close monitoring for signs of complications or adverse reactions is essential.
Clinical Status and Underlying Conditions
The patient's overall clinical status and any underlying medical conditions, such as severe liver dysfunction or significant coagulopathy, must be carefully considered, as they may affect the outcome of the procedure. The use of a 10F needle is a widely accepted standard for TIPS procedures and is generally considered safe and effective for most patients 1. However, the operator must always be prepared to adapt to any unexpected challenges or complications that may arise during the procedure.