Transjugular Intrahepatic Portosystemic Shunt
Reviewed and revised 20th October 2013
OVERVIEW
Transjugular Intrahepatic Portosystemic Shunt Procedure (TIPS) involves accessing the internal jugular vein and IVC to place a stent between the hepatic and portal veins using a needle
- this provides a conduit between the high pressure portal system and the lower pressure IVC system
- allows blood to bypass dilated oesophagus and gastric veins
- used in end stage liver failure
INDICATIONS
- variceal bleeding refractory to endoscopic banding or pharmacological measure
- ascites refractory to medical treatment
ANESTHETIC CONSIDERATIONS
- potential for massive haemorrhage and have a balloon tamponade in place -> resuscitate adequately
- haemodynamically stable induction
- invasive monitoring
- inotropes and blood products at the ready
COMPLICATIONS
- worsening of hepatic encephalopathy (high risk)
- pneumothorax
- arrhythmias
- massive bleeding
- infection
- failure of technique
- liver capsule perforation
- stent malposition, displacement or migration
- stent thrombosis or obstruction
References and Links
LITFL
- CCC – Gastrointestinal haemorrhage
- CCC – Upper Gastrointestinal Haemorrhage
- CCC – Lower Gastrointestinal Haemorrhage
- CCC – Transjugular Intrahepatic Portosystemic Shunt (TIPS) Procedure
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of two amazing children.
On Twitter, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC