Procedure

1. A sterile, water-soluble contrast agent (Renografin 60 or Hypaque 60) is drawn into a 60-ml syringe using sterile technique. All air bubbles in the contrast must be expelled from the syringe. The syringe is connected to a plastic extension tubing without a stopcock. The syringe and extension tubing are filled completely with the contrast agent, being careful to expel all of the air. The extension tube is clamped with a Kelly clamp or a plastic slide.

2. The patient is positioned supine on the fluoroscopic table.

3. The t-tube is clamped with a Kelly clamp, which has protective rubber tubing fitted over its teeth to prevent injury to the t-tube.

4. The bile bag is removed and set aside for reconnection to the t-tube after the procedure.

5. The contrast-filled syringe is attached to the t-tube by the extension tubing. Often a 15-gauge blunt needle or a Christmas-tree adapter must be used as a connector between the two. (Alternatively, the connection can be made with a 21-gauge needle on the extension tubing being passed obliquely through the t-tube wall.)