Norm of Splenoportography
Splenic pulp pressure: 50–180 mm H2O, or 3.5–13.5 mm Hg. Smooth flow of dye through the splenic venous system without obstruction or diversion. Timely flow of the dye through the hepatic portal system without evidence of collateral veins.
Usage of Splenoportography
Cirrhosis, hepatocellular carcinoma, and portal hypertension.
Description of Splenoportography
Splenoportography is the radiographic examination of the venous system of the spleen and portal system of the liver after injection of contrast medium directly into the splenic vein or splenic parenchyma. The measurement of splenic pulp pressure before dye injection helps detect portal hypertension.
Professional Considerations of Splenoportography
Consent form IS required.
Allergic reaction to contrast media (itching, hives, rash, tight feeling in the throat, shortness of breath, anaphylaxis); renal toxicity from contrast medium; hemorrhage requiring blood transfusion or splenectomy, or both.
Previous allergy to iodine, shellfish, or radiographic contrast media; pregnancy (if iodinated medium is used, because of the radioactive iodine crossing the blood-placental barrier); renal insufficiency; ascites; coagulation disorders; impaired hepatic or renal function; or splenic infection. Sedatives are contraindicated in clients with central nervous system depression.
- Establish intravenous access.
- Assess platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT), urea nitrogen, creatinine, and liver enzymes.
- Administer a sedative and an analgesic, as prescribed, 30 minutes before the test.
- Obtain antiseptic, sterile drapes, 1%–2% lidocaine (Xylocaine) local anesthetic, a percutaneous injection tray, a manometer, contrast medium, and material for a dry, sterile dressing.
- See Client and Family Teaching.
- Just before beginning the procedure, take a “time out” to verify the correct client, procedure, and site.
- The client is positioned supine with the left hand under the head.
- The left sides of the thorax and abdomen are washed with an antiseptic.
- The spleen is located by means of fluoroscopy.
- The puncture site is marked, usually the ninth or tenth intercostal space at the mid- or post-axillary line.
- After a local anesthetic is injected around the puncture site, a sheathed needle is inserted percutaneously into the spleen. The needle is removed, and the sheath is connected to a spinal manometer for splenic pulp pressure measurement.
- After sheath placement is verified, radiographic contrast medium is injected through the splenic parenchyma into the splenic vein, and cineradiographic films are taken to record splenic venous system filling.
- The needle is removed, and a dry, sterile dressing is applied to the puncture site.
- The procedure takes less than 1 hour.
- Assess vital signs every 15 minutes × 4, then every 30 minutes × 4, then hourly × 4, and then every 4 hours until 24 hours after the procedure.
- Observe for bleeding and swelling at the puncture site each time vital signs are taken.
Client and Family Teaching
- Fast from food and fluids from midnight before the test.
- A sensation of warmth or flushing after the dye injection is normal and will be transient.
- Immediately report any left upper quadrant pain.
- The client must assume a left side–lying position for 24 hours.
- The client may resume previous diet after the procedure. Oral intake of fluids, where not contraindicated, is encouraged.
Factors That Affect Results
- Cirrhosis causes delayed emptying of the intrahepatic radicles.
- Portal hypertension causes elevated splenic pulp pressure and evidence of the development of collateral veins.
- The newer computed tomographic percutaneous transsplenic portography (CT-PTSP) utilizes thinner needles for splenic puncture and CT rather than cineradiography. The use of thinner needles decreases the amount of pain and the risk of hemorrhage associated with the procedure. CT has a high-contrast resolution and can thus detect a low dose of contrast dye. CT-PTSP thus decreases the length of time that the client must be monitored and be on bed rest after the procedure and allows the procedure to be performed on an outpatient basis.
- CT during arterial portography (CTAP) is an alternative method of visualizing the portal venous system.