Subject(s)
Hypertension, Portal/surgery , Jugular Veins , Patient Care Planning , Portasystemic Shunt, Surgical/nursing , Humans , Hypertension, Portal/nursing , Hypertension, Portal/physiopathology , Male , Middle Aged , Portasystemic Shunt, Surgical/instrumentation , Portasystemic Shunt, Surgical/methods , Postoperative CareABSTRACT
The TIPS (transjugular intrahepatic portosystemic shunt) procedure is a relatively new therapeutic treatment option for variceal bleeding secondary to portal hypertension. The TIPS procedure evolved in response to the need for a safe, nonoperative shunting procedure, and is becoming a practical alternative to surgically placed shunts. Possible complications of a TIPS include hemorrhage, postprocedure sepsis, shunt encephalopathy or decompensation. Development of shunt stenosis or occlusion is associated with re-bleeding. Three children (ages 10-13) with recurrent, significant variceal bleeding were referred for the TIPS procedure. Two had recurrent GI hemorrhage despite sclerotherapy. To date, all have maintained shunt patency for up to 1 year. None of these children have had significant re-bleeding episodes, and the only recurrence of varices was associated with an obstructed shunt. In this article, the author reviews both conventional treatment and the TIPS procedure for the child with bleeding varices. Nursing implications from a pediatric perspective are emphasized. Pediatric GI nurses must understand TIPS in order to prepare the child and family and to monitor for complications or shunt failure afterward.
Subject(s)
Hypertension, Portal/surgery , Portasystemic Shunt, Surgical , Adolescent , Child , Female , Humans , Pediatric Nursing , Portasystemic Shunt, Surgical/adverse effects , Portasystemic Shunt, Surgical/methods , Portasystemic Shunt, Surgical/nursingSubject(s)
Esophageal and Gastric Varices/surgery , Portasystemic Shunt, Surgical/methods , Radiography, Interventional/methods , Adult , Endoscopy, Gastrointestinal , Esophageal and Gastric Varices/diagnostic imaging , Esophageal and Gastric Varices/pathology , Humans , Length of Stay/statistics & numerical data , Liver Transplantation , Male , Phlebography , Portasystemic Shunt, Surgical/instrumentation , Portasystemic Shunt, Surgical/nursing , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Radiography, Interventional/instrumentation , Radiography, Interventional/nursing , Recurrence , SclerotherapyABSTRACT
Interventional radiology has had a significant impact on patient care over the past 20 years, with the development of low-risk procedures. Nurses specialising in this field must maintain their knowledge of innovations to ensure that the nursing care of such patients remains appropriate. This article describes the indications for and procedural technique of transjugular intrahepatic portosystemic shunting (TIPS), a new initiative in interventional radiology. Although there are risks and side-effects, initial evidence of the method's efficacy suggests it has great potential in reducing morbidity and length of hospital stay.
