What is a 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 your child's neck and into the liver. This way, if the liver bleeds, blood goes into a vein, instead of your child's abdomen.

How is a transjugular liver biopsy performed?

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.)

Will my child be awake during the procedure?

No. Your child will be asleep, either through IV sedation or general anesthesia.

Will my child be in any 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 place the IV.

How long does the procedure take?

Approximately one hour.

What risks are associated with this procedure?

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)

What can I expect after the procedure?

Your child may experience some discomfort and will need to stay in bed for four hours in the recovery area. After approximately four hours, a 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.

When can I remove the bandage?

Leave the bandage on your child’s neck for 24 hours. Then you may remove the gauze and the clear bandage; do not remove the Steri-Strips® (white strips). If the Steri-Strips haven’t fallen off after seven days, you may remove them.

When can my child bathe?

Your child shouldn’t 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 your child’s neck dry. Once the Steri-Strips fall off, regular baths and showers are fine.

Are there any activity restrictions?

Your child should rest 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.