Primary Puncture Application And Operational Essentials Of The Chiba Needle

https://radiopaedia.org/articles/chiba-needle

Percutaneous transhepatic cholangiography (PTC) and subsequent percutaneous transhepatic biliary drainage (PTBD/PTCD) are important means for diagnosing and treating obstructive jaundice, and the Chiba needle is the "first blade" in this procedure.

Why the Chiba Needle Is Preferred for Initial Puncture

Intrahepatic bile ducts are only 2–4 mm in diameter (often 3–8 mm when dilated). The outer diameter of a 21G or 22G Chiba needle is very small (0.7–0.9 mm), causing minimal damage to the bile duct wall and liver parenchyma, with low risks of bleeding and bile leakage. Moreover, its hollow lumen is sufficient to aspirate and confirm bile or inject a small amount of contrast agent to visualize the biliary tree.

Standard Operating Procedure

• Positioning and Anesthesia:​ The patient lies supine/left oblique. Use ultrasound or fluoroscopy to determine the right mid-axillary line at the 7th–9th intercostal space as the puncture point (directed toward the porta hepatis), and administer local anesthesia to the liver capsule.
• Puncture and Confirmation:​ Instruct the patient to hold their breath. Insert the 21G/22G Chiba needle along the predetermined angle. Upon reaching the liver parenchyma, withdraw the stylet and slowly withdraw the needle while gently aspirating - seeing golden-yellow bile or aspirating bile with a micro-syringe confirms entry into the bile duct.
• Cholangiography:​ Inject 2–5 mL of diluted contrast agent (e.g., 30% meglumine diatrizoate) through the Chiba needle for PTC to display the obstruction site, extent, and upstream bile duct dilation.
• Guidewire Exchange and Drainage Establishment:​ Introduce a 0.018″ or 0.035″ micro-guidewire through the Chiba needle into the bile duct and advance it beyond the obstruction into the duodenum. Withdraw the Chiba needle, sequentially dilate to establish a tract, and place a multi-side-hole drainage catheter for external or internal-external drainage.

Precautions and Complications

Avoid probing the same tract more than 3 times to prevent intrahepatic hematoma;

The puncture point should not be too high to avoid pneumothorax, nor too low to avoid colon puncture;

Postoperatively monitor blood pressure, abdominal signs, and drainage fluid color; mild biliary bleeding is mostly self-limiting, while massive bleeding requires interventional embolization;

Biliary peritonitis mostly occurs when the side holes of the drainage catheter are not completely within the bile duct and requires timely adjustment.

In this scenario, the Chiba needle plays the role of a "gateway opener" - its thin, flexible, and highly visible characteristics directly determine the initial success rate and safety of PTC/PTBD.