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In the daily workflow of interventional radiology and hepatobiliary surgery, the two core applications of the PTC needle (Chiba-type) are diagnostic Percutaneous Transhepatic Cholangiography (PTC) and the establishment of initial biliary access for therapeutic Percutaneous Transhepatic Cholangial Drainage (PTCD). For PTC needle manufacturers, providing standardized operational guidance alongside products is a key element in enhancing clinical satisfaction and brand professionalism.

Preoperative Assessment and Preparation:​ Patients must be screened for iodine contrast allergy and severe coagulopathy (INR >1.5 or PLT <50×10⁹/L). Vitamin K₁ and prophylactic antibiotics are administered preoperatively. Manufacturers typically recommend equipping with a 22G×150 mm or 200 mm Chiba needle (with stylet), accompanied by a 0.018″ micro-guidewire, dilators, and subsequent pigtail drainage catheters-forming a complete PTC/PTCD kit.

Puncture Pathway Selection:​ The right approach commonly selects the right mid-axillary line at the 8th–9th intercostal space, targeting dilated right anterior or posterior hepatic duct branches. The left approach uses a subxiphoid slightly leftward puncture of the inferior left hepatic duct (superficial, unobstructed by ribs, suitable for ultrasound guidance). Manufacturers can include schematic diagrams of typical puncture pathways in product manuals to assist junior operators in quickly mastering the technique.

Image Guidance and Puncture:​ Ultrasound real-time guidance is recommended. The Chiba needle tip appears as a hyperechoic "comet-tail" artifact on ultrasound. Advancing along the guidance line, the operator senses a breakthrough feeling (slight indentation of the bile duct wall + sudden drop of the needle tip), then removes the stylet to observe bile return-confirming successful puncture. This step is extremely sensitive to tip grinding quality: a premium PTC needle, with precision bevel grinding and electropolishing, offers a clear breakthrough sensation and minimal resistance; an inferior needle with a rolled edge forces repeated attempts, increasing the risk of liver injury.

Contrast Injection and Subsequent Management:​ Slowly inject non-ionic low-concentration contrast (iohexol 20%–30%) through the Chiba needle lumen-avoid pressurized air injection. Under DSA fluoroscopy, the full biliary tree is revealed-obstruction site, extent, and communication between left and right hepatic ducts become clearly visible. If PTCD is required, advance a 0.018″ micro-guidewire through the Chiba needle lumen (note: the 22G Chiba needle inner diameter is approx. 0.41 mm, accommodating only ≤0.018″ guidewires; forcing a 0.035″ wire is prohibited), withdraw the puncture needle, sequentially dilate over the wire, and place the drainage catheter.

Manufacturers' Added-Value Recommendations:​ PTC needle manufacturers can provide: ① Chiba needles in various lengths/specifications (20G–23G, 150/200/250 mm); ② PTC starter kits preloaded with 0.018″ hydrophilic-coated micro-guidewires; ③ Instructions for adapter compatibility with ultrasound puncture probe guides; ④ Bilingual (Chinese-English) procedural cards (including contraindications, pressure warnings for contrast injection). This "product + clinical solution" model is more competitive than simply selling needles and reduces customer complaints arising from misuse (e.g., clogging the lumen with an oversized guidewire).

It is worth emphasizing that the Chiba-type PTC needle itself does not directly place the drainage catheter; its core value lies in safely establishing the first access, followed by wire exchange for subsequent therapy. This "fine-needle first-pass" concept is precisely the essence of how Chiba needles reduce PTC/PTCD complications. Manufacturers should repeatedly communicate this concept to clinicians during promotion, preventing users from mistakenly believing that fine needles are less "efficient" than coarse trocars-in reality, fine-needle first-pass + exchange is the safe pathway recommended by modern guidelines.